{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:43:35Z","timestamp":1790628215369,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T00:00:00Z","timestamp":1639440000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Up to 20% of patients with moderate to severe Graves' orbitopathy (GO) do not respond to high\u2010dose glucocorticoids (GC). A few studies, including a randomized trial, have demonstrated the efficacy of interleukin\u20106 (IL\u20106) blockade with tocilizumab (TCZ) in GC\u2010refractory GO. However, data on predictors of response to TCZ and long\u2010term outcomes are lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Observational single\u2010center study on ten consecutive patients treated with TCZ for GC\u2010refractory GO, between 2016 and 2020. Median (interquartile range) follow\u2010up was 24 (12\u201336) months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Inflammation and exophthalmos improved dramatically in all patients within months after starting TCZ. Mean Clinical Activity Score decreased from 4.80\u2009\u00b1 \u20091.13 to 0.70\u2009\u00b1\u20090.82 points at 6 months (mean change: \u22124.10\u2009\u00b1\u20091.52; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). Proptosis improved from 23.2\u2009\u00b1\u20092.1 to 20.6\u2009\u00b1\u20092.0\u2009mm at 6 months (mean change: \u22122.9\u2009\u00b1\u20091.4\u2009mm; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). Diplopia resolved in 7 patients. Thyroid receptor antibodies decreased markedly during TCZ treatment. Baseline serum IL\u20106 levels did not predict clinical response. TCZ was well\u2010tolerated. During follow\u2010up, 3 patients were diagnosed with cancer (breast cancer in 2 and urothelial cancer in 1).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TCZ was rapidly effective and well\u2010tolerated in our patients with GC\u2010refractory GO. Four patients experienced mild\/moderate adverse events as neutropenia, hyperlipidemia, and infections; nearly a third developed cancer during the follow\u2010up. The increased incidence observed could be explained by the high prevalence of smokers, that are at higher risk for Graves' orbitopathy and solid malignancies as breast cancer. Thus, regular cancer screening could be proposed to this vulnerable population receiving high doses of immunosuppressants.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14655","type":"journal-article","created":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T03:20:04Z","timestamp":1639538404000},"page":"363-370","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Long\u2010term outcomes in corticosteroid\u2010refractory Graves' orbitopathy treated with tocilizumab"],"prefix":"10.1111","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7890-944X","authenticated-orcid":false,"given":"Laura","family":"Moi","sequence":"first","affiliation":[{"name":"Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital Lausanne University Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehrad","family":"Hamedani","sequence":"additional","affiliation":[{"name":"Department of Oculoplasty, Jules\u2010Gonin Eye Hospital Lausanne University Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camillo","family":"Ribi","sequence":"additional","affiliation":[{"name":"Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital Lausanne University Lausanne 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