Real-world evidence of treatment for relapse of noninfectious uveitis in tertiary centers in Japan
Real-world evidence of treatment for relapse of noninfectious uveitis in tertiary centers in Japan
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日本三级中心治疗非感染性葡萄膜炎复发的真实世界证据
DOI：
10.1097/md.0000000000014668
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发表时间：
2019
期刊：
影响因子：
1.6
通讯作者：
Mizuki Nobuhisa
中科院分区：
文献类型：
--
作者：
Takeuchi Masaru;Kanda Takayuki;Kaburaki Toshikatsu;Tanaka Rie;Namba Kenichi;Kamoi Koju;Maruyama Kazuichi;Shibuya Etsuko;Mizuki Nobuhisa
非感染性葡萄膜炎（NIU）是一种以全身综合征或仅在眼部发生的疾病，其发病机制常为自身免疫性。NIU的标准治疗是局部、外用和口服皮质类固醇（CS）联合免疫调节治疗（IMT）。然而，尚未建立涉及局部和全身施用CS或其他药物以治疗NIU中眼部炎症复发或恶化的其他治疗策略，这些眼部炎症表现为各种眼部表现。本研究的目的是调查用于各种眼部炎症复发或加重的NIU的治疗策略，并评估与日本的治疗模式相关的因素。研究对象为日本6所大学医院的156例眼部炎症复发或加重的NIU患者的198只眼。最常见的疾病是结节病，占23.7%，其次是白塞病（BD），占21.2%，Vogt-Koyanagi-Harada（VKH）病，占13.6%，急性前葡萄膜炎（AAU），占5.6%，肾小管间质性肾炎和葡萄膜炎综合征（TINU），占4.0%，幼年特发性关节炎（JIA）相关葡萄膜炎，占3.0%。常见的眼部表现为前部炎症（AI）加重（67.2%）、玻璃体混浊（VO）（46.5%）、黄斑水肿（ME）（26.8%）、视网膜血管炎（RV）（23.7%）、浆液性视网膜脱离（SRD）（9.1%）和视神经束膜炎（OPN）（4.0%）。单用倍他米滴眼液（艾德）强化治疗单侧和双侧AI，Tenon下注射曲安奈德（STTA）治疗单侧后部炎症（包括VO和ME），以及使用CS和/或IMT全身治疗双侧前部和后部炎症的频率显著更高。结节病和BD患者眼部症状加重的频率相似，与全葡萄膜炎相关的严重眼部炎症需要局部和全身治疗。这些结果表明，强化倍他米松ED、局部给予曲安奈德和长期给予全身性皮质类固醇是主要的治疗策略，并且强化倍他米松ED用于加重AI独立于其用于后部炎症。此外，STTA优先用于与后部炎症相关的VO和ME。
Noninfectious uveitis (NIU), which pathogenesis is often autoimmune nature, occurs as a symptom of systemic syndromes or only in the eye. The standard treatment of NIU is local, topical, and oral administration of corticosteroids (CS) in combination with immunomodulatory therapy (IMT). However, additional therapeutic strategies involving topical and systemic administration of CS or others to treat relapse or exacerbation of ocular inflammation in NIU which present as various ocular manifestations have not been established. The aim of this study was to investigate therapeutic strategies used for various ocular inflammations in relapse or exacerbation of NIU and to evaluate factors associated with the treatment pattern in Japan. The subjects were 198 eyes of 156 NIU patients with relapse or exacerbation of ocular inflammation at 6 university hospitals in Japan. The most frequent disease was sarcoidosis in 23.7% of the cases, followed by Behçet disease (BD) in 21.2%, Vogt-Koyanagi-Harada (VKH) disease in 13.6%, acute anterior uveitis (AAU) in 5.6%, tubulointerstitial nephritis and uveitis syndrome (TINU) in 4.0%, and juvenile idiopathic arthritis (JIA)-associated uveitis in 3.0%. Common ocular findings were worsened anterior inflammation (AI) in 67.2% of the cases, vitreous opacity (VO) in 46.5%, macular edema (ME) in 26.8%, retinal vasculitis (RV) in 23.7%, serous retinal detachment (SRD) in 9.1%, and optic perineuritis (OPN) in 4.0%. Reinforcement of betamethasone eye drop (ED) monotherapy for only AI in both unilateral and bilateral AI, sub-tenon injection of triamcinolone acetonide (STTA) for unilateral posterior inflammation including VO and ME, and systemic therapy using CS and/or IMT for bilateral anterior and posterior inflammation were significantly more frequent. Frequencies of exacerbated individual ocular findings in sarcoidosis and BD were similar, and severe ocular inflammation associated with panuveitis required both topical and systemic therapies. These results demonstrate that reinforcement of betamethasone EDs, topical administration of triamcinolone acetonide, and long-term administration of systemic corticosteroids are the major therapeutic strategies, and reinforcement of betamethasone EDs was used for exacerbated AI independently from its use for posterior inflammation. In addition, STTA was preferentially used for VO and ME associated with posterior inflammation.