系统评价免疫抑制剂和生物疗法治疗自身免疫性后部葡萄膜炎的疗效。
Systematic review on the effectiveness of immunosuppressants and biological therapies in the treatment of autoimmune posterior uveitis.
机构信息
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
出版信息
Semin Arthritis Rheum. 2011 Feb;40(4):314-23. doi: 10.1016/j.semarthrit.2010.05.008. Epub 2010 Jul 24.
OBJECTIVES
To analyze the effectiveness of immunosuppressants and biological therapies in autoimmune posterior uveitis, chronic anterior uveitis associated with juvenile idiopathic arthritis, and macular edema.
METHODS
Systematic review. We conducted a sensitive literature search in Medline (from 1961) and EMBASE (from 1980) until October 2007. Selection criteria were as follows: (1) population: autoimmune posterior uveitis, chronic anterior uveitis in juvenile idiopathic arthritis, and macular edema; (2) intervention: immunosuppressive and biologic therapies; (3) outcomes: visual acuity, Tyndall, vitreous haze, macular edema, pars planitis, and retinal vasculitis. There were no limitations regarding study design. The quality of each study was evaluated using the Jadad's scale and Oxford Levels of Evidence.
RESULTS
Two hundred sixty-five articles were selected for detailed review of the 4235 found in the initial search: 128 records were on immunosuppressants, 105 on biological therapies, and 32 on macular edema. Overall, both the immunosuppressive and the biologic therapies appeared effective in the treatment of autoimmune posterior uveitis, except for daclizumab in uveitis related to Behçet's disease, and for etanercept in any uveitis. In the treatment of macular edema, the drugs tested were also effective.
CONCLUSIONS
Based on the evidence collated, immunosuppressants and biological therapies (except for daclizumab in Behçet and etanercept) may be effective in autoimmune uveitis and macular edema. No superiority may be inferred from this review.
目的
分析免疫抑制剂和生物疗法在自身免疫性后葡萄膜炎、与幼年特发性关节炎相关的慢性前葡萄膜炎和黄斑水肿中的疗效。
方法
系统评价。我们对 Medline（始于 1961 年）和 EMBASE（始于 1980 年）进行了敏感的文献检索，检索截止日期为 2007 年 10 月。选择标准如下：（1）人群：自身免疫性后葡萄膜炎、幼年特发性关节炎的慢性前葡萄膜炎和黄斑水肿；（2）干预措施：免疫抑制和生物治疗；（3）结局：视力、Tyndall 现象、玻璃体混浊、黄斑水肿、脉络膜炎和视网膜血管炎。研究设计没有任何限制。使用 Jadad 量表和牛津证据等级评估每个研究的质量。
结果
在初始搜索中发现的 4235 篇文章中，有 265 篇文章被选中进行详细审查：128 篇关于免疫抑制剂，105 篇关于生物疗法，32 篇关于黄斑水肿。总体而言，免疫抑制剂和生物疗法似乎对自身免疫性后葡萄膜炎的治疗有效，但贝切特氏病相关葡萄膜炎中的达克珠单抗和任何葡萄膜炎中的依那西普除外。在黄斑水肿的治疗中，所测试的药物也有效。
结论
根据汇集的证据，免疫抑制剂和生物疗法（除了贝切特氏病中的达克珠单抗和依那西普）可能对自身免疫性葡萄膜炎和黄斑水肿有效。本综述无法推断出任何优势。
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