Key indicators for guiding tocilizumab therapy to prevent orbital decompression surgery in hormone-resistant dysthyroid optic neuropathy

作者：Wenjun Shu, Mingxu Yan, Lu Gan, Lu Li, Hongyue Tao, Zhiyu Peng, Jinghan Wang, Xiaofeng Li, Xintong Lin, Haifeng Chen, Jie Guo, Kang Xue, Hongguang Cui, Heng Lou, Binbin Xu, Jin-Wei Cheng, Hongying Ye, Yiming Li, Qian Jiang, Rui Zhang, Ruiqi Ma, Fangfang Zeng · 发表于：Frontiers in Immunology · 年份：2025 · DOI：10.3389/fimmu.2025.1556742 · 被引用次数：4 · 研究领域：Ophthalmology and Eye Disorders、Vestibular and auditory disorders、Glaucoma and retinal disorders

Introduction Tocilizumab (TCZ) has been demonstrated to be effective in treating thyroid-associated ophthalmopathy (TAO); however, its efficacy in hormone-resistant dysthyroid optic neuropathy (DON) remains unclear. This study aims to identify baseline and post-treatment indicators that can predict the necessity for surgical intervention following TCZ therapy. Methods Thirty-one hormone-resistant DON patients treated with TCZ were categorized into surgery (n=15, 7 males, 8 females) and non-surgery (n=16, 8 males, 8 females) groups based on their post-TCZ surgical status. Retrospective comparisons between the two groups were performed using pre- and post-treatment ophthalmic assessments, biomarkers, and orbital magnetic resonance imaging (MRI) scans. The predictive value of identified variables was evaluated through receiver operating characteristic (ROC) curve analysis and logistic regression analysis. Results The surgery group exhibited a significantly higher baseline thyroid-stimulating hormone receptor antibody (TRAb) ( P =0.001) and a positive change in the maximal signal intensity ratio of extraocular muscle to temporalis muscle (SIR(EOM/temporalis) MAX ), whereas the non-surgery group demonstrated a negative change ( P <0.001). A TRAb cut-off value of ≤5.07 IU/L predicted non-surgery with 93.3% sensitivity and 81.2% specificity, while a SIR(EOM/temporalis) MAX cut-off value of ≤-1.83 had 86.7% sensitivity and 87.5% specificity. The area under the curve was 0.846 ...