Tocilizumab in Birdshot Retinopathy Nuria Pfeiffer Esther Corredera

Tocilizumab in Birdshot Retinopathy Nuria Pfeiffer Esther Corredera Óscar Gutiérrez Justo Ruiz

Birdshot Retinopathy Posterior Uveitis Chronic Bilateral Autoinmune response

Birdshot Retinopathy Hipopigmented retinal lesions Cystoid Macular edema

Clinical Case A 76 year-old woman refering bilateral progressive visual loss - Visual acuity: Right eye 0, 2 PH 0, 3 Left eye 0, 5 PH 0, 7

Clinic Case AVASTIN BOTH EYES

Maybe Ozurdex ? 1 month Average effect 1 -2 months 4 months

Maybe Ozurdex + Azathioprine (Imuran)? Ozurdex 6 months 11 months

Maybe Ozurdex + Azathioprine (Imuran) +Mycophenolate ? 1 month Ozurdex 10 months 4 months

Maybe Ozurdex + Infiximab +Metotrexato ? 1 month 4 months 8 months

Maybe Tocilizumab + Metotrexato ? 1 month 2 months 6 months

CONCLUSIONS DATE OD mar-12 Ozurdex abr-12 OI 1 Month 201/220 jun-12 Imurel 727/223 sep-12 Ozurdex 229/568 abr-13 Ozurdex jul-13 Ozurdex feb-14 Micofenolato + Imurel jun-14 Ozurdex may-15 abr-16 may-16 620/217 250/420 Ozurdex 226/567 ? /214 624/193 221/397 Infiximab+Metotrexato feb-16 319/269 235/288 feb-14 dic-14 4 Months 206/549 Ozurdex nov-12 2 Months Ozurdex Tocilizumab+ Metotrexato 569/540 681/337 530/569 560/493 520/368 200/230 290/249 381/233 222/209 213/228

CONCLUSIONS Macular thickness after 4 months treatment 700 600 500 400 300 200 100 0 Azathioprine + Mycophenolate Infiximab + metotrexate Tocilizumab + metotrexate

Evolution. Right eye. 800 Azathiopine Azathioprine + Mycophenolate 700 600 500 400 Tozilizumab 300 200 100 0 Ozurdex

CONCLUSIONS Birdshot Retinophaty is usually refractive to any treatment. Ozurdex is a short term solution. Systemic treatment is needed.

CONCLUSIONS In our patient the response to Tocilizumab has been effective and long lasting. Tozilizumab should be considered as an promising option for these patients.

Thank you for your attention! Nuria Pfeiffer Esther Corredera Óscar Gutiérrez Justo Ruiz