El-Shabrawi Yosuf, Hermann Josef
Department of Ophthalmology, Karl Franzens University, Graz, Austria.
Ophthalmology. 2002 Dec;109(12):2342-6. doi: 10.1016/s0161-6420(02)01292-7.
To evaluate the potentials of infliximab, a mouse-human chimeric immunoglobulin G1 monoclonal antibody that binds both the soluble form and the membrane-bound precursor of tumor necrosis factor-alpha (TNF-alpha), thus inhibiting a broad range of biologic activities of TNF-alpha, in the therapy of patients with acute HLA B27-associated anterior uveitis.
Prospective noncomparative case series.
Seven consecutive patients with acute onset of HLA B27-associated anterior uveitis, with at least three anterior chamber cells.
Infliximab IV (Centocor, Malvern, PA) at a dosage of 10 mg/kg body weight was used as the only anti-inflammatory drug.
Anterior chamber cells and flare were evaluated before infliximab treatment and at defined time points after treatment. C-reactive protein (CRP) levels were assessed in all patients before IV delivery of infliximab and were re-evaluated after 1 week.
Patients were observed for a mean period of 17 +/- 0.8 months. Seven patients received a single infliximab infusion of 10 mg/kg body weight. One patient received a second infusion 3 weeks after the first because of a uveitis flare-up. The median duration (+/- standard deviation) of uveitis was 8 +/- 12 days. All patients responded to infliximab with immediate improvement of clinical symptoms and a rapid decrease in anterior chamber cells. Total resolution of the uveitis was achieved with infliximab as the sole anti-inflammatory drug in all but one patient, who also showed systemic inflammatory activity, as indicated by a threefold increase in the serum CRP level. A relapse was seen in four patients after a median period of 5 +/- 6.4 months.
Infliximab proved to be a powerful therapeutic agent in acute HLA B27-associated uveitis and may therefore be a future alternative or supplement to steroid treatment. Larger controlled studies on the efficacy and dosage of infliximab in different forms of anterior uveitis will nonetheless be needed to evaluate the effectiveness of anti-TNF-alpha treatment in acute, as well as chronic, uveitis.
评估英夫利昔单抗（一种鼠-人嵌合免疫球蛋白G1单克隆抗体，可结合可溶性肿瘤坏死因子-α（TNF-α）和膜结合前体TNF-α，从而抑制TNF-α的多种生物学活性）治疗急性HLA B27相关性前葡萄膜炎患者的潜力。
前瞻性非对照病例系列研究。
7例连续急性发作的HLA B27相关性前葡萄膜炎患者，前房至少有3个细胞。
使用英夫利昔单抗静脉注射（Centocor公司，宾夕法尼亚州马尔文），剂量为10mg/kg体重，作为唯一的抗炎药物。
在英夫利昔单抗治疗前及治疗后的特定时间点评估前房细胞和房水闪辉。在所有患者静脉输注英夫利昔单抗前评估C反应蛋白（CRP）水平，并在1周后重新评估。
患者平均观察期为17±0.8个月。7例患者接受了一次10mg/kg体重的英夫利昔单抗输注。1例患者因葡萄膜炎复发在首次输注后3周接受了第二次输注。葡萄膜炎的中位持续时间（±标准差）为8±12天。所有患者对英夫利昔单抗治疗均有反应，临床症状立即改善，前房细胞迅速减少。除1例患者外，所有患者仅使用英夫利昔单抗作为抗炎药物即可使葡萄膜炎完全消退，该患者血清CRP水平升高3倍，提示存在全身炎症活动。4例患者在中位时间5±6.4个月后复发。
英夫利昔单抗在急性HLA B27相关性葡萄膜炎中被证明是一种有效的治疗药物，因此可能成为未来类固醇治疗的替代药物或补充药物。然而，仍需要对英夫利昔单抗在不同类型前葡萄膜炎中的疗效和剂量进行更大规模的对照研究，以评估抗TNF-α治疗在急性和慢性葡萄膜炎中的有效性。
