Infliximab treatment for ocular and extraocular manifestations of Behcet's disease
Infliximab treatment for ocular and extraocular manifestations of Behcet's disease
复制标题
DOI：
10.1007/s10384-006-0425-y
复制
发表时间：
2007-05-01
影响因子：
2.4
通讯作者：
Pivetti-Pezzi, Paola
中科院分区：
文献类型：
--
作者：
Accorinti, Massimo;Pirraglia, Maria Pia;Pivetti-Pezzi, Paola
目的：评估英夫利昔单抗治疗白克特病患者威胁视力的葡萄膜炎和眼外表现的有效性和安全性。方法：12 例白克特病合并葡萄膜炎患者在用其他免疫抑制药物治疗失败后接受英夫利昔单抗治疗。主要结果指标如下：葡萄膜炎复发的数量、白塞氏病相关眼外病变的数量、治疗期间以及患者服用其他免疫抑制剂之前相同时间段内皮质类固醇的给药量。在英夫利昔单抗治疗开始和随访结束时记录视力，如果与基线相比没有变化，则定义为稳定；如果与基线相比至少改善一行，则定义为增加；如果与基线至少下降一行，则定义为下降。 结果：在平均随访 16.67 +/- 7.63 个月（中位数为 15 个月）期间，11 名患者（91.6%）显示视力数量减少。眼部复发（复发/月，从 0.35 +/- 0.17 到 0.12 +/- 0.17，P < 0.001）。所有在英夫利昔单抗治疗前服用皮质类固醇的患者 (n = 11) 在英夫利昔单抗治疗期间能够减少每天服用的皮质类固醇的量（从每天 24.33 +/- 10.84 mg/泼尼松到每天 8.97 +/- 6.81 mg/泼尼松，P < 0.001），并且所有患者的眼外表现均出现减少。 Behqet 病（平均总数，从 2.83 +/- 3.61 到 1.51 +/- 2.35，P = 0.039）。一名患者因肺结核发作而在开始治疗 2 个月后不得不停止治疗，该患者在英夫利昔单抗治疗期间出现相同数量的复发，但能够减少平均每日皮质类固醇剂量。三只眼睛（12.5%）的视力提高了一条或多条线，87.5%的眼睛保持不变。 4 名患者（33.3%）出现了与英夫利昔单抗相关的副作用。结论：英夫利昔单抗对于治疗这些白克特病患者的葡萄膜炎是有效的，显着减少了眼部复发的数量，并使得每日皮质类固醇的给药剂量显着减少。 Behqet 病的眼外表现也可以通过英夫利昔单抗控制。然而，副作用并不少见，在英夫利昔单抗给药前必须对全身状况进行广泛的研究，以排除全身感染，特别是既往结核病。
Purpose: To assess the efficacy and safety of infliximab in the treatment of sight-threatening uveitis and extraccular manifestations in patients with Behqet's disease.Methods: Twelve patients with Behqet's disease and uveitis were treated with infliximab after unsuccessful therapy with other immunosuppressive drugs. The main outcome measures were as follows: the number of uveitis relapses, the number of Behcet's disease-related extraocular lesions, and the amount of corticosteroids administered during the treatment as well as during an equal prior period of time while the patients were on other immunosuppressive agents. Visual acuity was recorded at the beginning of infliximab therapy and at the end of follow-up, and was defined as stable if it did not change from baseline, increased if it showed at least one line of improvement from baseline, and decreased if it showed at least a one line decrease from baseline.Results: During an average follow-up of 16.67 +/- 7.63 months (median, 15 months), 11 patients (91.6%) showed a reduction in the number of ocular relapses (relapse/month, from 0.35 +/- 0.17 to 0.12 +/- 0.17, P < 0.001). All of the patients (n = 11) who were taking corticosteroids before infliximab were able to reduce the amount of corticosteroids taken daily during infliximab treatment (from 24.33 +/- 10.84 mg/prednisone per day to 8.97 +/- 6.81 mg/prednisone per day, P < 0.001), and all presented with a reduced onset of extraocular manifestations of Behqet's disease (mean total number, from 2.83 +/- 3.61 to 1.51 +/- 2.35, P = 0.039). One patient, who had to stop treatment 2 months after starting because of the onset of pulmonary tuberculosis, showed the same number of relapses during infliximab treatment but was able to reduce the mean daily corticosteroid dose. Visual acuity increased by one or more lines in three eyes (12.5%) and remained unchanged in 87.5% of the eyes. Infliximab-related side effects appeared in four patients (33.3%).Conclusions: Infliximab was effective in the treatment of uveitis in these Behqet's disease patients, significantly reducing the number of ocular relapses and making possible a significant reduction in the daily dose of corticosteroids administered. Extraocular manifestations of Behqet's disease were also controlled by infliximab. Nevertheless, side effects were not uncommon, and an extensive study of systemic conditions before infliximab administration had to be carried out to exclude systemic infection, particularly prior tuberculosis.