Alternative Biologic Therapy in Children Failing Conventional TNFα Inhibitors for Refractory, Noninfectious, Chronic Anterior Uveitis.
Alternative Biologic Therapy in Children Failing Conventional TNFα Inhibitors for Refractory, Noninfectious, Chronic Anterior Uveitis.
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传统 TNFα 抑制剂治疗难治性、非感染性、慢性前葡萄膜炎失败的儿童的替代生物疗法。
DOI：
10.1016/j.ajo.2022.06.024
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发表时间：
2022
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
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作者：
MiraldiUtz,Virginia;Angeles-Han,SheilaT;Mwase,Najima;Cassedy,Amy;Hennard,Theresa;Lovell,DanielJ;Lopper,Sarah;Brunner,HermineI;Dosunmu,EniolamiO;Grom,AlexeiA;Henrickson,Michael;Huggins,JenniferL;Sisk,RobertA;Ting,TracyV;
大量非感染性慢性前葡萄膜炎（CAU）患儿对常规治疗无效;然而，成功的替代生物治疗（ABT）尚未得到很好的描述。本研究旨在回顾需要ABT的CAU患儿的临床和治疗特征。设计回顾性、非随机临床研究。方法设置：三级中心。研究人群：非感染性CAU患儿。观察程序：比较接受甲氨蝶呤（MTX）单药治疗、常规TNFα抑制剂（cTNFi）和ABT治疗>3个月的患者的临床特征、葡萄膜炎病程、并发症和治疗。主要结局指标：成功的ABT（阿巴西普，托珠单抗，和/或戈利木单抗）在儿童未能常规treatment.ResultsOf 52名儿童CAU，75%的青少年特发性关节炎。15名接受MTX单药治疗的儿童、28名接受cTNFi治疗的儿童和9名接受ABT治疗的儿童（n = 1，阿巴西普; n = 3，托珠单抗; n = 5，戈利木单抗）的CAU得到控制。ABT组患者在ABT前的总眼部并发症人数多于对照组（分别为3.4 vs 0.7 [MTX]，P<0.001和1.5 [cTNFi]，P<0.001）。在所有9名儿童ABT，治疗导致控制CAU和局部糖皮质激素逐渐减少到≤2滴/d，没有新的眼部并发症conclusionsIn this study，替代生物制剂（阿巴西普，戈利木单抗，托珠单抗）是有用的治疗CAU的儿童谁失败MTX和cTNFi治疗。接受ABT控制的患者比接受常规治疗的患者具有更多的疾病活动性、眼部并发症和抗cTNFi中和抗体（ABT前）。需要更大规模的研究来证实这些发现。
PurposeA significant number of children with noninfectious, chronic anterior uveitis (CAU) fail to respond to conventional therapy; however, successful alternative biologic treatments (ABT) have not been well described. This study aims to review the clinical and treatment characteristics of children with CAU who require ABT.DesignRetrospective, nonrandomized clinical study.MethodsSetting:Tertiary center.Study Population:Children with noninfectious CAU.Observation Procedures:Clinical characteristics, uveitis course, complications, and treatment were compared among patients treated with methotrexate (MTX) monotherapy, conventional TNFα inhibitors (cTNFi), and ABT for >3 months.Main Outcome Measure:Success of ABT (abatacept, tocilizumab, and/or golimumab) in children failing conventional treatment.ResultsOf the 52 children with CAU, 75% had juvenile idiopathic arthritis. CAU was controlled in 15 children receiving MTX monotherapy, 28 receiving cTNFi, and 9 receiving ABT (n = 1, abatacept; n = 3, tocilizumab; n = 5, golimumab). Patients in the ABT group had a greater number of total ocular complications per person before ABT than those in the control groups (3.4 vs 0.7 [MTX],P< .001, and 1.5 [cTNFi],P< .001, respectively). In all 9 children on ABT, treatment led to control of CAU and topical glucocorticoids tapered to ≤2 drops/d with no new ocular complications.ConclusionsIn this study, alternative biologics (abatacept, golimumab, and tocilizumab) were useful for treating CAU in children who fail MTX and cTNFi therapy. Patients who were controlled on ABT had more disease activity, ocular complications, and anti-cTNFi neutralizing antibodies (before ABT) than those managed with conventional therapy. Larger studies are required to confirm these findings.