Cyclosporine for ocular inflammatory diseases.
Cyclosporine for ocular inflammatory diseases.
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DOI：
10.1016/j.ophtha.2009.08.010
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发表时间：
2010-03
期刊：
影响因子：
13.7
通讯作者：
Foster CS
中科院分区：
文献类型：
--
作者：
Kaçmaz RO;Kempen JH;Newcomb C;Daniel E;Gangaputra S;Nussenblatt RB;Rosenbaum JT;Suhler EB;Thorne JE;Jabs DA;Levy-Clarke GA;Foster CS
评价环孢霉素治疗非感染性眼部炎症的临床结局回顾性队列研究在1979-2007年（含）期间，在美国的四个三级眼部炎症诊所治疗的373名非感染性眼部炎症患者观察到使用环孢霉素作为其治疗方案的单一非皮质类固醇免疫抑制剂。参与者是从眼部疾病的全身免疫抑制治疗队列研究中确定的。在每次访视时，通过经过培训的专家审查员的病历审查，获得每例患者每只眼的人口统计学和临床特征，包括环孢素剂量和主要结局指标。主要结局指标：控制炎症，减少皮质类固醇剂量后持续控制，因毒性而停止治疗。在373例（681只眼）开始环孢霉素单药治疗的患者中，33.4%的患者在6个月内和51.9%的患者在1年内获得了持续的、完全的炎症控制，至少两次访视持续至少28天。到每个时间点，大约25%以上的炎症活动改善到轻微的炎症活动水平。保留皮质类固醇的成功率（使用泼尼松10 mg/天或更少，炎症完全控制至少28天）在6个月内达到22.1%，在1年内达到36.1%。毒性导致10.7%的人群在一年内停止治疗。55岁以上的患者因毒性而停止治疗的可能性是18-39岁患者的3倍以上。151-250 mg/天的剂量往往比较低剂量更成功，并且与较高的毒性停药率无关;较高的剂量似乎没有提供治疗优势。环孢霉素，与皮质类固醇治疗的适应症，是适度有效的控制眼部炎症。我们的数据支持环孢素成人剂量在151-250 mg/天之间的偏好。虽然大多数患者能够耐受环孢素，但随着年龄的增长，毒性发生率更高;对于55岁以上的患者，首选替代药物。
To evaluate the clinical outcomes of cyclosporine treatment for non-infectious ocular inflammation Retrospective cohort study Three hundred seventy-three patients with non-infectious ocular inflammation managed at four tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single non-corticosteroid immunosuppressive agent to their treatment regimen, between 1979-2007 inclusive. Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine and main outcome measures were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures: Control of inflammation, sustained control after reducing corticosteroid dosages, and discontinuation of therapy because of toxicity. Of the 373 patients (681 eyes) initiating cyclosporine monotherapy, 33.4% by six months and 51.9% by one year gained sustained, complete control of inflammation over at least two visits spanning at least 28 days. Approximately 25% more improved to a level of slight inflammatory activity by each of these time points. Corticosteroid-sparing success (completely controlled inflammation for at least 28 days with prednisone 10 mg/day or less) was achieved by 22.1% by six months and 36.1% within one year. Toxicity led to discontinuation of therapy within one year by 10.7% of the population. Patients over 55 years of age were over 3-fold more likely to discontinue therapy because of toxicity than patients ages 18-39 years. Doses of 151-250 mg/day tended to be more successful than lower doses, and were not associated with a higher discontinuation for toxicity rate; higher doses did not appear to offer a therapeutic advantage. Cyclosporine, with corticosteroid therapy as indicated, was modestly effective for controlling ocular inflammation. Our data support a preference for cyclosporine adult dosing between 151-250 mg/day. While cyclosporine was tolerated by the majority of patients, toxicity was much more frequent with increasing age; alternative agents may be preferred for patients over 55 years of age.
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影响因子：
13.7
作者：
Kiss, S;Ahmed, M;Foster, CS
通讯作者：
Foster, CS
影响因子：
1.8
作者：
Kempen, John H.;Daniel, Ebenezer;Suhler, Eric B.
通讯作者：
Suhler, Eric B.
影响因子：
0.9
作者：
Hesselink, DA;Baarsma, GS;van Hagen, PM
通讯作者：
van Hagen, PM
影响因子：
--
作者：
Murphy, CC;Greiner, K;Dick, AD
通讯作者：
Dick, AD
影响因子：
158.5
作者：
PALESTINE, AG;AUSTIN, HA;NUSSENBLATT, RB
通讯作者：
NUSSENBLATT, RB