Anti-TNF-α therapy in patients with refractory uveitis due to Behcet's disease: a 1-year follow-up study of 124 patients
Anti-TNF-α therapy in patients with refractory uveitis due to Behcet's disease: a 1-year follow-up study of 124 patients
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DOI：
10.1093/rheumatology/keu266
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发表时间：
2014-12-01
期刊：
影响因子：
5.5
通讯作者：
Gonzalez-Gay, Miguel A.
中科院分区：
文献类型：
--
作者：
Calvo-Rio, Vanesa;Blanco, Ricardo;Gonzalez-Gay, Miguel A.
客观的。本研究的目的是评估抗 TNF-α 疗法对白塞氏病 (BD) 引起的难治性葡萄膜炎的疗效。方法。我们对 124 名 BD 葡萄膜炎患者进行了一项多中心研究，这些患者对常规治疗（包括大剂量皮质类固醇和至少一种标准免疫抑制剂）难治。患者接受英夫利昔单抗 (IFX)（第 0、2 和 6 周 3-5 mg/kg，然后每 4-8 周）或阿达木单抗 (ADA)（通常每 2 周 40 mg/kg）治疗至少 12 个月。主要观察指标为前后房炎症程度、视力、黄斑厚度和免疫抑制负荷。结果。对 68 名男性和 56 名女性（221 只受影响的眼睛）进行了研究。平均年龄为 38.6 岁（标准差 10.4）。 66.1% 的患者 HLA-B51 呈阳性，78.2% 的患者为双侧葡萄膜炎。 IFX 是 77 例 (62%) 病例中的首选生物制剂，ADA 是 47 例 (38%) 病例中的首选生物制剂。在大多数情况下，抗TNF-α药物与常规免疫抑制药物联合使用。在抗 TNF-α 治疗开始时，分别有 57% 和 64.4% 的患者出现前房和玻璃体炎症。在这两种情况下，一年后损害均显着减少。基线时，50 名患者（80 只眼）出现黄斑增厚 [光学相干断层扫描 (OCT) >250 μm]，35 名患者（49 只眼）出现黄斑囊样水肿 (OCT > 300 μm)，从基线时的 420 mm (S.D. 119.5) 改善到第 12 个月时的 271 μm (S.D. 45.6) (P < 0.01）。最佳矫正视力和抑制负荷也显示出显着改善。 1年随访后，67.7%的患者不活动。在大多数情况下，生物治疗的耐受性良好。结论。抗 TNF-α 疗法对于难治性 BD 葡萄膜炎有效且相对安全。
Objective. The aim of this study was to assess the efficacy of anti-TNF-alpha therapy in refractory uveitis due to Behcet's disease (BD).Methods. We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load.Results. Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (S.D. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-alpha drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-alpha therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 mu m] and 35 (49 eyes) had cystoid macular oedema (OCT > 300 mu m) that improved from 420 mm (S.D. 119.5) at baseline to 271 mu m (S.D. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases.Conclusion. Anti-TNF-alpha therapy is effective and relatively safe in refractory BD uveitis.