Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis due to Behcet's Disease: National Multicenter Study of 177 Cases
Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis due to Behcet's Disease: National Multicenter Study of 177 Cases
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DOI：
10.1002/art.41026
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发表时间：
2019-10-21
影响因子：
13.3
通讯作者：
Blanco, Ricardo
中科院分区：
文献类型：
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作者：
Atienza-Mateo, Belen;Luis Martin-Varillas, Jose;Blanco, Ricardo
目的比较英夫利昔单抗（IFX）和阿达木单抗（ADA）作为一线生物制剂治疗白塞病（BD）所致难治性葡萄膜炎1年的疗效。方法我们进行了一项开放标签的多中心研究，比较IFX与ADA治疗常规非生物治疗难治性BD相关葡萄膜炎的疗效。IFX或ADA被选为一线生物制剂的基础上医生和患者的协议。患者在第0、2和6周以及此后每4-8周接受3-5 mg/kg静脉内IFX，或每隔一周皮下注射40 mg ADA，无负荷剂量。比较两组间的眼部参数。结果177例患者（316只眼），其中103例接受IFX治疗，74例接受ADA治疗。治疗组之间在主要人口统计学特征、既往治疗或眼部体征严重程度方面没有显着的基线差异。治疗1年后，我们观察到两组的所有眼部参数均有所改善。然而，接受ADA治疗的患者在某些参数方面有明显更好的结果，包括前房炎症的改善（92.31% vs. IFX组78.18%; P = 0.06），玻璃体炎改善（IFX组为93.33% vs 78.95%; P = 0.04）和最佳矫正视力（平均值+/- SD 0.81 +/- 0.26 vs 0.67 +/- 0.34; P = 0.001）。黄斑厚度无显著性差异（ADA组平均值± SD 250.62 ± 36.85，IFX组平均值± SD 264.89 ± 59.74; P = 0.15），两组视网膜血管炎的改善相似（ADA组95%，IFX组97%; P = 0.28）。ADA组的药物留存率更高（95.24% vs IFX组的84.95%; P = 0.042）。结论：尽管IFX和ADA治疗难治性BD相关葡萄膜炎均有效，但随访1年后，ADA的疗效优于IFX。
Objective To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first-line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to Behcet's disease (BD). Methods We conducted an open-label multicenter study of IFX versus ADA for BD-related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first-line biologic agent based on physician and patient agreement. Patients received 3-5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4-8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups. Results The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best-corrected visual acuity (mean +/- SD 0.81 +/- 0.26 versus 0.67 +/- 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean +/- SD 250.62 +/- 36.85 for ADA versus 264.89 +/- 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042). Conclusion Although both IFX and ADA are efficacious in refractory BD-related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow-up.