Treatment of Refractory Uveitis with Adalimumab: A Prospective Multicenter Study of 131 Patients
Treatment of Refractory Uveitis with Adalimumab: A Prospective Multicenter Study of 131 Patients
复制标题
DOI：
10.1016/j.ophtha.2012.02.018
复制
发表时间：
2012-08-01
期刊：
影响因子：
13.7
通讯作者：
Fernando Arevalo, J.
中科院分区：
文献类型：
--
作者：
Diaz-Llopis, Manuel;Salom, David;Fernando Arevalo, J.
目的：评价阿达木单抗治疗难治性葡萄膜炎的疗效。设计：前瞻性病例系列。参与者：共有131名难治性葡萄膜炎患者，对强的松和至少1种其他全身免疫抑制药物不耐受或无效。干预：患者每隔一周接受40mg阿达木单抗皮下注射，持续6个月。相关免疫抑制剂在给予3次阿达木单抗注射后逐渐减少（第6周）。主要观察指标：前后房炎症程度（葡萄膜炎命名标准化工作组标准）、免疫抑制负荷（Nussenblatt等人定义）、视力（最小分辨角的对数[logMAR]）和黄斑厚度（光学相干断层扫描）。结果：男性61例，女性70例，平均年龄27.3岁。最常见的原因是39例青少年特发性关节炎，16例足底部炎，13例白塞氏病。27例患者为特发性葡萄膜炎。82%的患者出现前房炎症，59%的患者出现玻璃体腔炎症。6个月时，前房炎症和玻璃体炎症的平均值分别从基线时的1.51和1.03下降到0.25和0.14，显著降低（P < 0.001）。基线时黄斑厚度为296（102）亩，而6个月时为240（36）亩（P < 0.001）。150只眼中有32只（21.3%）视力改善-0.3 logMAR， 5只（3.3%）视力恶化+0.3 logMAR（-15个字母）。皮质类固醇的剂量也从0.74 (3.50)mg/kg/d降至0.20 (0.57)mg/kg/d （P < 0.001）。40只眼在基线时出现囊样黄斑水肿，6个月后28只眼完全消退。平均抑制负荷显著降低（8.81 [5.05]vs 5.40 [4.43]; P < 0.001）。研究开始6个月后，111名患者（85%）能够将其基线免疫抑制负荷降低至少50%。在6个月的随访中，仅有9例（6.9%）出现严重复发。结论：阿达木单抗似乎耐受性良好，有助于降低难治性葡萄膜炎的炎症活性，并可能减少类固醇的需求。阿达木单抗治疗葡萄膜炎的进一步对照研究是有必要的。财务披露：作者在本文中讨论的任何材料中没有专有或商业利益。眼科2012;119:1575-1581 (C) 2012由美国眼科学会。
Objective: To evaluate adalimumab therapy in refractory uveitis.Design: Prospective case series.Participants: A total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated.Intervention: Patients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6).Main Outcome Measures: Degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thickness (optical coherence tomography).Results: There were 61 men and 70 women (mean age, 27.3 years). The most common causes were juvenile idiopathic arthritis in 39 patients, pars planitis in 16 patients, and Behcet's disease in 13 patients. Twenty-seven patients had uveitis of idiopathic origin. Inflammation in the anterior chamber was present in 82% of patients and in the vitreous cavity in 59% of patients. Anterior chamber inflammation and vitreous inflammation decreased significantly (P < 0.001) from a mean of 1.51 and 1.03 at baseline to 0.25 and 0.14, respectively, at 6 months. Macular thickness was 296 (102) mu at baseline versus 240 (36) mu at the 6-month visit (P < 0.001). Visual acuity improved by -0.3 logMAR in 32 of 150 eyes (21.3%) and worsened by +0.3 logMAR (-15 letters) in 5 eyes (3.3%). The dose of corticosteroids also decreased from 0.74 (3.50) to 0.20 (0.57) mg/kg/day (P < 0.001). Cystoid macular edema, which was present in 40 eyes at baseline, showed complete resolution in 28 eyes at 6 months. The mean suppression load decreased significantly (8.81 [5.05] vs 5.40 [4.43]; P < 0.001). Six months after the initiation of the study, 111 patients (85%) were able to reduce at least 50% of their baseline immunosuppression load. Only 9 patients (6.9%) had severe relapses during the 6 months of follow-up.Conclusions: Adalimumab seems to be well tolerated and helpful in decreasing inflammatory activity in refractory uveitis and may reduce steroid requirement. Further controlled studies of adalimumab for uveitis are warranted.Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2012;119:1575-1581 (C) 2012 by the American Academy of Ophthalmology.