SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Inflammation Pharmacology
This article is part of the Research TopicVolume II: Anti-Inflammatory Drug Development Focusing on Immune Mediated DiseasesView all 9 articles
Effectiveness and Safety of Tocilizumab in Refractory Non-Infectious Uveitis: A Systematic Review and Meta-analysis
Provisionally accepted
- West China Hospital of Sichuan University, Chengdu, China
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Purpose: To comprehensively evaluate the efficacy and safety of tocilizumab in patients with refractory non-infectious uveitis (NIU) through a systematic review and meta-analysis. Methods: A comprehensive literature search was conducted across PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov from inception to July 13, 2025. Eligible studies included case series and cohort studies evaluating clinical outcomes of tocilizumab in NIU. Study quality was assessed using the Joanna Briggs Institute Case Series Checklist and Newcastle-Ottawa Scale. A single-arm meta-analysis was performed using a random-effects model. Results: Thirteen studies involving 374 patients were included. The pooled rate of sustained inactive uveitis was 57.08% (95% CI: 46.94%-66.96%), and overall inflammation remission rate at final follow-up was 75.23% (95% CI: 64.04%-85.09%). Macular edema resolved in 93.22% of patients (95% CI: 86.76%-98.01%), with a mean reduction in central macular thickness of 143.57 µm. Mean visual acuity improved by -0.29 logarithm of the minimum angle of resolution (logMAR) (95% CI: - 0.55 to -0.04). The pooled glucocorticoid discontinuation rate was 40.25% (95% CI: 13.43%- 70.27%). During the follow-up period, the pooled incidence of adverse events and serious adverse events was 13.05% (95% CI: 8.88%-17.78%) and 4.41% (95% CI: 1.08%-9.16%), respectively. Subgroup analysis suggested greater efficacy among patients treated for ≥9 months. Conclusion: Tocilizumab provides meaningful clinical benefit with acceptable safety in refractory NIU related to autoimmune and inflammatory diseases, particularly in patients with macular edema. These results support the use of tocilizumab as a viable second-line therapeutic option following the failure of conventional immunosuppressants and anti-tumor necrosis factor alpha agents.
Keywords: tocilizumab, Uveitis, Interleukin-6 inhibition, Systemic autoimmune disease, macularedema, Visual Acuity, Corticosteroid-sparing
Received: 28 Aug 2025; Accepted: 11 Nov 2025.
Copyright: © 2025 Kang, Wu, Xu, Huang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ming Zhang, zhangmingscu0905@163.com
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