Outcome of adalimumab monotherapy in paediatric non-infectious uveitis.
Outcome of adalimumab monotherapy in paediatric non-infectious uveitis.
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DOI：
10.1186/s12969-023-00794-y
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发表时间：
2023-03-02
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阿达木单抗联合其他缓解疾病的抗风湿药物（DMARD），如甲氨蝶呤，在儿科非感染性葡萄膜炎的治疗中具有已证实的疗效。然而，许多儿童在使用这种组合时对甲氨蝶呤有明显的不耐受性，这给临床医生选择后续治疗路线图带来了困境。在这种情况下，继续阿达木单抗单药治疗可能是一种可行的替代选择。本研究旨在研究阿达木单抗单药治疗儿童非感染性葡萄膜炎的疗效。本回顾性研究纳入了接受阿达木单抗单药治疗（从2015年8月至2022年6月）、对伴随使用的甲氨蝶呤或霉酚酸酯不耐受的非感染性葡萄膜炎儿童。在阿达木单抗单药治疗开始时和末次访视前每隔3个月收集数据。主要结局是评价阿达木单抗单药治疗的疾病控制，根据随访期间葡萄膜炎恶化小于2级（根据SUN评分）且未使用额外全身免疫抑制的患者比例确定。次要结局指标为阿达木单抗单药治疗的视力结局、并发症和副作用特征。收集了28例患者（56只眼）的数据。葡萄膜炎类型以前葡萄膜炎最常见，病程以慢性葡萄膜炎最常见。幼年特发性关节炎相关性葡萄膜炎是最常见的潜在诊断。在研究期间，23例（82.14%）研究受试者符合主要结局。在Kaplan-Meier生存分析中，81.25%（95% CI; 60.6-91.7%）的儿童在阿达木单抗单药治疗12个月时维持缓解。对于阿达木单抗与甲氨蝶呤或霉酚酸酯联合治疗不耐受的儿童，继续阿达木单抗单药治疗是治疗非感染性葡萄膜炎的有效治疗选择。
Adalimumab in combination with other disease-modifying antirheumatic drugs (DMARD) such as methotrexate has a proven efficacy in the management of paediatric non-infectious uveitis. However, many children experience significant intolerance to methotrexate while on this combination, leaving a dilemma for clinicians for choosing the subsequent therapeutic roadmap. Continuation of adalimumab monotherapy might be an alternative feasible option under such settings. This study aims to investigate the efficacy of adalimumab monotherapy in paediatric non-infectious uveitis. Children with non-infectious uveitis on adalimumab monotherapy (from August 2015 to June 2022) following intolerance to accompanying methotrexate or mycophenolate mofetil were included in this retrospective study. Data were collected at the initiation of adalimumab monotherapy and at three monthly intervals until the last visit. The primary outcome was to evaluate disease control on adalimumab monotherapy as determined by the proportion of patients who had less than a 2-step worsening in uveitis (as per SUN score) and no additional systemic immunosuppression during follow-up. Secondary outcome measures were visual outcome, complications and side-effect profile of adalimumab monotherapy. Data was collected for 28 patients (56 eyes). The most common uveitis type and course were anterior and chronic uveitis respectively. Juvenile idiopathic arthritis-associated uveitis was the most common underlying diagnosis. During the study period, 23 (82.14%) of the study subjects met the primary outcome. On Kaplan–Meier survival analysis 81.25% (95% CI; 60.6–91.7%) children maintained remission at 12 months on adalimumab monotherapy. Continuation of adalimumab monotherapy is an effective therapeutic option for the treatment of non-infectious uveitis in children who are intolerant to the combination of adalimumab and methotrexate or mycophenolate mofetil.
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DOI：
10.1034/j.1600-0420.2000.078001084.x
发表时间：
2000-02-01
期刊：
ACTA OPHTHALMOLOGICA SCANDINAVICA
影响因子：
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作者：
Päivönsalo-Hietanen, T;Tuominen, J;Saari, KM
通讯作者：
Saari, KM
影响因子：
--
作者：
Bulatovic, Maja;Heijstek, Marloes W.;Wulffraatl, Nico M.
通讯作者：
Wulffraatl, Nico M.
影响因子：
6.5
作者：
van der Kraaij, Gayle;Busard, Celine;Spuls, Phyllis
通讯作者：
Spuls, Phyllis
影响因子：
5.2
作者：
Skrabl-Baumgartner, Andrea;Seidel, Gerald;Jahnel, Joerg
通讯作者：
Jahnel, Joerg
影响因子：
5
作者：
Heiligenhaus, A.;Minden, K.;Lehmann, H. W.
通讯作者：
Lehmann, H. W.