Tocilizumab for Non-Infectious Uveitis: A Systematic Review.

Non-infectious uveitis (NIU) comprises a heterogeneous group of diseases causing severe ocular inflammation that threatens vision. In addition to visual impairment, patients frequently endure chronic pain, functional disorders, and psychosocial stress, all of which substantially reduce quality of life. Treating NIU remains challenging because many patients respond inadequately to high-dose corticosteroids and various immunosuppressants. This systematic review evaluated the efficacy and safety of tocilizumab (TCZ) in NIU treatment by analyzing case reports and small-scale studies. A systematic search of PubMed, Web of Science, and Embase up to May 1, 2025, identified all published cases reporting baseline and follow-up visual acuity alongside intervention details. The Newcastle-Ottawa Scale (NOS) assessed methodological quality, while the Joanna Briggs Institute (JBI) tool evaluated risk of bias. The systematic review included 96 patients (36 males, 60 females) with an average age of 35 years (range 4-72). Behçet's disease (BD) represented the most common underlying condition (33 cases), and panuveitis was the primary anatomical subtype (35 cases). Prior to TCZ initiation, patients had received an average of 2.8 conventional immunosuppressants and 1.6 biologics, yet persistent disease activity remained. The median interval from diagnosis to TCZ treatment was 11.8 months (range 4-24). Following TCZ administration, vision improved in 62.5% of patients, intraocular inflammation was controlled in 83.3%, and macular edema resolved in 90.9%. Overall, 83.3% (80/96) responded favorably to TCZ. These findings indicate that TCZ may serve as an effective alternative for managing refractory NIU when other treatments fail.