Rahman M U, Poe D S, Choi H K
Rheumatology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Otol Neurotol. 2001 Sep;22(5):619-24. doi: 10.1097/00129492-200109000-00010.
Immune-mediated cochleovestibular disorders (IMCVDs) continue to present a management challenge to the otolaryngologist. Antirheumatic agents, commonly used for IMCVDs, are associated with variable efficacy and sometimes with serious side effects. The authors describe the preliminary result of their experience in patients with IMCVDs who have been treated with etanercept, a tumor necrosis factor alpha receptor blocker, recently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis.
Retrospective case series.
Tertiary care hospital.
Twelve patients suspected of having IMCVD who did not respond to conventional therapies or experienced side effects of the conventional therapies.
Etanercept 25 mg by subcutaneous injection twice per week.
The main outcome measurement was assessment of hearing change by air conduction pure tone audiograms and/or word discrimination. When present, vertigo, tinnitus, and aural fullness were assessed as well.
Follow-up of more than 5 months was available for all patients (range, 5-12 months). Eleven (92%) of 12 patients had improvement or stabilization of hearing and tinnitus, seven (88%) of eight patients who had vertigo and eight (89%) of nine patients who had aural fullness had resolution or significant improvement of their symptoms. The benefit persisted until the last visit (5-12 months after etanercept was begun). The condition of one patient improved dramatically at first but deteriorated after 5 months. The patient's hearing was rescued and stabilized with the addition of leflunomide to etanercept. Similarly, three other patients required a second antirheumatic agent to stabilize their hearing. There were no significant side effects from the etanercept therapy.
Our limited data suggest that etanercept therapy is safe and may be efficacious in carefully selected patients with IMCVDs, at least on a short-term basis. These preliminary efficacy and safety results appear encouraging enough to warrant further follow-up and studies for better determination of the potential clinical utility of etanercept for IMCVDs.
免疫介导的耳蜗前庭疾病（IMCVDs）仍然给耳鼻喉科医生的治疗带来挑战。常用于IMCVDs的抗风湿药物疗效不一，有时还会伴有严重的副作用。作者描述了他们使用依那西普治疗IMCVDs患者的初步经验结果，依那西普是一种肿瘤坏死因子α受体阻滞剂，最近已被美国食品药品监督管理局批准用于治疗类风湿关节炎。
回顾性病例系列研究。
三级医疗中心。
12名疑似患有IMCVD且对传统疗法无反应或出现传统疗法副作用的患者。
皮下注射依那西普25毫克，每周两次。
主要观察指标是通过气导纯音听力图和/或言语识别来评估听力变化。如有眩晕、耳鸣和耳闷，也进行评估。
所有患者均有超过5个月的随访（范围为5 - 12个月）。12名患者中有11名（92%）听力和耳鸣得到改善或稳定，8名有眩晕症状的患者中有7名（88%）、9名有耳闷症状的患者中有8名（89%）症状得到缓解或显著改善。这种益处一直持续到最后一次随访（开始使用依那西普后5 - 12个月）。有1名患者起初病情显著改善，但5个月后恶化。在依那西普基础上加用来氟米特后，该患者的听力得到挽救并稳定。同样，另外3名患者需要第二种抗风湿药物来稳定听力。依那西普治疗未出现明显副作用。
我们有限的数据表明，依那西普治疗在精心挑选的IMCVDs患者中是安全的，至少在短期内可能有效。这些初步的疗效和安全性结果似乎令人鼓舞，足以保证进一步随访和研究，以便更好地确定依那西普对IMCVDs的潜在临床应用价值。
