Abstract General Information

Title

Experience with tocilizumab for neuromyelitis optica spectrum disorders in northeast of Brazil

Case Report

Case Presentation: We present 4 nonwhite patients with neuromyelitis optica (NMO) aquaporin 4 positives treated with monthly intravenous (IV) tocilizumab (TOZ).
Case 1: a 31-year-old (yo) woman with an associated collagen disease. When she was 12 yo, she had an optic neuritis (ON) plus longitudinal extensive transverse myelitis (LETM). The first treatment was azathioprine (AZA) plus oral corticosteroid (OC) with 8 relapses. So, she used rituximab (RIX) with also 8 relapses. Then TOZ was prescribed, with no relapses for 1.6 yeas (yrs). She has visual impairment and paraparesis (EDSS 5.0).
Case 2: a 33-yo woman had a bilateral ON when she was 21 yo. She used AZA/OC for 2.5 yrs. Then, she had NO plus LETM at age 28. She used IV cyclophosphamide (CTX) and AZA, with a new outbreak. Then it was switched to RIX, even so she had 4 relapses in less than 1 year. So, she changed to TOZ plus IVIg. Despite good control for 1.4 yrs, she is bedridden.
Case 3: A 23-yo woman with the first LETM at age 20. She had 2 relapses in 1 year, so RIX was started. Despite this, she already had a new severe attack after 11 months. TOZ was initiated with no relapses for 1.1 yrs and EDSS still 6.5.
Case 4: A 39-yo woman, with arterial hypertension and atrial fibrillation. She had a LETM when she was 36 yo. After 2 relapses, she started CTX and AZA. Unfortunately, she had a cervical myelitis with need of respiratory support. So, she is under TOZ for less than one year. She still requires a wheelchair.
Discussion: We presented a series of severe NMO cases with great control and tolerance with TOZ.
Final Comments: TOZ has increasing evidence of efficacy for NMO and is a good option when other treatments fail.