Efficacy and safety of Tocilizumab for thyroid eye disease: a systemic review and Meta-analysis.

Purpose: This study aims to investigate efficacy and safety of TCZ in TED.

Methods: Performing a meta-analysis of included studies. PubMed, Web of Science, Embase, Cochrane Library, and Clinicatrials.gov databases were retrieved to identify all related published literatures as of May 2024. When I² > 50%, the random effect model was used; otherwise, the fixed model was used.

Results: This meta-analysis included 413 patients with TED. Therapeutic effect of TCZ was evaluated by various metrics, including clinical activity score (CAS), response rate, inactivation rate, proptosis, visual acuity (VA), TRAB/TSI levels, diplopia, eye motility, intraocular pressure (IOP), and relapse rate. The final analysis revealed that TCZ significantly reduced CAS (-4.47, 95%CI [-5.14, -3.79]), with high response rate (0.93, 95%CI [0.88, 0.97]) and inactivation rate (0.90, 95%CI [0.83, 0.96]). Significant improvements were also observed in proptosis (2.05 mm reduction, 95%CI [-2.42, -1.67]) and diplopia (0.56 improvement rate, 95% CI [0.40, 0.72]). Regarding safety, the pooled incidence of adverse events (AEs) was 0.31(95%CI [0.15, 0.48]). Hyperlipidemia was the most prevalent AE, followed by neutropenia and infection. Furthermore, subgroup analysis demonstrated TCZ's superior performance in terms of inactivation rate, antibody decline rate, relapse rate, and safety.

Conclusions: According to the best available evidence, TCZ appears to be an acceptable alternative for moderate to severe TED patients due to its significant efficacy, well-tolerability, and low relapse rate. Larger sample size and controlled studies are warranted to promote the position of TCZ in TED treatment.