An Update on Treatment of Pediatric Chronic Non-Infectious Uveitis.
An Update on Treatment of Pediatric Chronic Non-Infectious Uveitis.
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DOI：
10.1007/s40674-017-0057-z
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发表时间：
2017-03
影响因子：
1.2
通讯作者：
Angeles-Han ST
中科院分区：
文献类型：
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作者：
Sood AB;Angeles-Han ST
目前尚无儿童非感染性葡萄膜炎的标准化治疗方案。局部皮质类固醇是典型的一线药物，尽管全身皮质类固醇用于中间、后、全葡萄膜性葡萄膜炎。由于潜在的眼部和全身副作用，皮质类固醇不被认为是长期治疗。对于患有严重和/或难治性葡萄膜炎的儿童，及时使用高剂量的疾病改善抗风湿药（DMARDs）和生物制剂是很重要的。在病程早期增加剂量可能会改善疾病控制和改善视力。一般来说，甲氨蝶呤是常用的一线类固醇保留剂，由于生物利用度更好，每周一次皮下注射，剂量为0.5 mg/kg/剂或10-15 mg/m2。其他dmard，如霉酚酸盐、硫唑嘌呤和环孢素是治疗儿童葡萄膜炎的较不常见的药物。抗肿瘤坏死因子- α药物，主要是英夫利昔单抗和阿达木单抗，在甲氨蝶呤难治性儿童中用作二线药物，或在出现严重并发症时用作一线治疗。英夫利昔单抗在给药后至少每4周给药7.5 mg/kg，最多20 mg/kg。阿达木单抗每周可给予20或40毫克。在抗肿瘤坏死因子- α药物无效、产生抗肿瘤坏死因子- α抗体、出现不良反应或耐受困难的儿童中，关于后续治疗的可用数据较少。托珠单抗每2-4周输注一次，阿巴接受每月输注一次，利妥昔单抗输注一次，结果令人鼓舞。
There are no standardized treatment protocols for pediatric non-infectious uveitis. Topical corticosteroids are the typical first-line agent, although systemic corticosteroids are used in intermediate, posterior and panuveitic uveitis. Corticosteroids are not considered to be long-term therapy due to potential ocular and systemic side effects. In children with severe and/or refractory uveitis, timely management with higher dose disease-modifying antirheumatic drugs (DMARDs) and biologic agents is important. Increased doses earlier in the disease course may lead to improved disease control and better visual outcomes. In general, methotrexate is the usual first-line steroid-sparing agent and given as a subcutaneous weekly injection at >0.5 mg/kg/dose or 10–15 mg/m2 due to better bioavailability. Other DMARDs, for instance mycophenolate, azathioprine, and cyclosporine are less common treatments for pediatric uveitis. Anti-tumor necrosis factor-alpha agents, primarily infliximab and adalimumab are used as second line agents in children refractory to methotrexate, or as first-line treatment in those with severe complicated disease at presentation. Infliximab may be given at a minimum of 7.5 mg/kg/dose every 4 weeks after loading doses, up to 20 mg/kg/dose. Adalimumab may be given up to 20 or 40 mg weekly. In children who fail anti-tumor necrosis factor-alpha agents, develop anti-tumor necrosis factor-alpha antibodies, experience adverse effects, or have difficulty with tolerance, there is less data available regarding subsequent treatment. Promising results have been noted with tocilizumab infusions every 2–4 weeks, abatacept monthly infusions and rituximab.