Efficacy and safety of adalimumab in the treatment of non-infectious uveitis: a meta-analysis and systematic review.
Efficacy and safety of adalimumab in the treatment of non-infectious uveitis: a meta-analysis and systematic review.
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阿达木单抗治疗非感染性葡萄膜炎的疗效和安全性：荟萃分析和系统评价
DOI：
10.2147/dddt.s160431
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Lei B
中科院分区：
文献类型：
--
作者：
Ming S;Xie K;He H;Li Y;Lei B
总结阿达木单抗（ADA）治疗非感染性葡萄膜炎患者的有效性和安全性的最新证据。使用PubMed、Embase和科克伦图书馆进行了2000年1月至2017年9月的系统检索。我们研究了炎症控制、视力（VA）改善、皮质类固醇节省效应和不良事件（AE）或严重不良事件。纳入3项随机临床试验（RCT）和20项非RCT进行分析。在≤6个月和≥12个月随访持续时间组中，炎症控制的汇总比例分别为74%（95% CI 64%-82%）和79%（95% CI 69%-87%）。两组比较差异无统计学意义（χ2 = 0.920，p = 0.337）。按抗TNF α药物初治程度分类的亚组分析显示，当受试者在ADA治疗前“几乎未接受过”抗TNF α治疗时，炎症控制率高达87%（95% CI 80%-92%）。41.3%（52/126）的患眼视力提高3行或3行以上，88.8%（142/160）的患眼视力等于或优于基线。82.0%（91/111）的患者保留了糖皮质激素，其中48.8%（40/82）的患者完全停用糖皮质激素。报告了轻微的药物相关不良事件。ADA的治疗效果在3项RCT中基本一致，ADA可降低43%-75%的治疗失败风险。本综述提供的证据表明，ADA在治疗非感染性葡萄膜炎时，在降低炎症活动、获得VA和避免使用皮质类固醇（伴有轻微AE）方面可能是一种有希望的选择。
To summarize updated evidences on the efficacy and safety of adalimumab (ADA) in the treatment of patients with non-infectious uveitis. A systematic search between January 2000 and September 2017 was conducted using PubMed, Embase, and Cochrane libraries. We investigated control of inflammation, improvement of visual acuity (VA), corticosteroid-sparing effect, and adverse events (AEs) or serious adverse events. Three randomized clinical trials (RCTs) and 20 non-RCTs were included and analyzed. The pooled proportions of inflammation control were 74% (95% CI 64%–82%) and 79% (95% CI 69%–87%) in groups of ≤6- and ≥12-months follow-up durations. No significant difference was found between the two groups (χ2 = 0.920, p = 0.337). Analysis of subgroups classified by degree of being treatment-naïve for anti-TNFα agents showed the inflammation control reached a high of 87% (95% CI 80%–92%) when subjects were “almost naïve” to anti-TNFα before ADA treatment. VA was improved by three or more lines in 41.3% (52/126) eyes, and was equal to or better than the baseline in 88.8% (142/160) eyes. Corticosteroid sparing was observed in 82.0% (91/111) of the patients; among them, 48.8% (40/82) discontinued use of corticosteroid completely. Minor drug-related adverse events were reported. The treatment effects of ADA were generally consistent in the three RCTs, and ADA reduced the risk of treatment failure by 43%–75%. The current review provided evidences that ADA might be a promising choice in reducing inflammatory activity, gaining VA, and sparing corticosteroid use with minor AEs when applied in treating non-infectious uveitis.