RESUMO
PURPOSE: To review existing literature concerning the effectiveness and safety of tocilizumab (TCZ) for managing thyroid eye disease. METHODS: A systematic search was conducted across the PubMed and Embase databases to identify studies on TCZ therapy, from inception to May 2023. The search included the keywords "Graves orbitopathy," "thyroid ophthalmopathy," "thyroid eye disease," "thyroid-associated orbitopathy," "thyroid-associated ophthalmopathy," "Graves ophthalmopathy," "endocrine ophthalmopathy," and "Tocilizumab." Only articles written in English, Spanish, or French were considered. RESULTS: Among the 1,013 articles initially screened, a total of 29 fulfilled the eligibility criteria and were selected. Most studies were case reports or case series, and only one randomized clinical trial was found. TCZ has been used mainly in glucocorticoid-resistant or relapsing cases, with a dosage ranging from 4 or 8 mg/kg every 4 weeks when intravenous or a weekly subcutaneous dose of 162 mg. Treatment duration is usually adjusted to the clinical response. TCZ is mostly effective in reducing inflammatory signs during the active phase of thyroid eye disease, with an improvement of at least 3 points in clinical activity score and an overall relapsing rate of 8.2%. Numerous studies have shown marked reductions in proptosis; although the only available randomized controlled trial reported a nonstatistically significant improvement 6 months after treatment, a recent meta-analysis indicated that TCZ seems to be the most effective treatment for reducing proptosis. No severe side effects related to intravenous or subcutaneous TCZ administration were reported. DISCUSSION: Despite these promising findings, randomized clinical trials to directly compare the efficacy and safety of TCZ and other currently available therapeutic options are needed.
Assuntos
Anticorpos Monoclonais Humanizados , Oftalmopatia de Graves , Humanos , Oftalmopatia de Graves/tratamento farmacológico , Oftalmopatia de Graves/diagnóstico , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Resultado do TratamentoRESUMO
Sub-mesoscale and mesoscale (i.e., 1-10 km and 10-200 km, respectively) ocean processes are highly relevant for the understanding of global circulation, mixing of water masses and energy exchange between ocean layers. However, the processes happening at these scales are hard to be characterized using direct measurements of temperature and salinity. Direct measurements are obtained from vertical probes and/or autonomous vehicles, which, despite their high vertical resolution, are sparsely located in space and therefore unable to capture spatial details at these scales. Seismic oceanography (SO) data have been successfully used to imaging and characterize the ocean at these spatial scales. These data represent indirect measurements of the ocean temperature and salinity along kilometric transects with high horizontal resolution (i.e., a near-synaptic view of the system under investigation), but lower vertical resolution when compared with direct observations. Despite its complex oceanographic setting, the Madeira Abyssal Plain is still largely uncharacterized due to the lack of direct observations. We show for the first time a comprehensive processing, modelling and interpretation of three 2-D seismic oceanography sections from this region. The data show coherent seismic reflection in space, depth and time and shed light into this oceanographic setting with an unprecedent horizontal resolution. The SO modelling and interpretation are combined with existing direct measurements and a quantitative method to correlate thermohaline staircases interpreted from conductivity-temperature-depth casts and seismic reflections is proposed. The results show the relatively stable presence of thermohaline staircases in simultaneously time and space between 1200 and 2000 m of water depth and their spatial variability and contribute to the generalization of SO in physical oceanography.