Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK.
Rheumatology (Oxford). 2012 Dec;51(12):2199-203. doi: 10.1093/rheumatology/kes212. Epub 2012 Aug 25.
To assess the use of adalimumab in the treatment of refractory non-infectious childhood chronic uveitis.
A case cohort interventional study was performed on patients with uveitis, who were treated with adalimumab after failure of treatment with a combination of corticosteroids and another immunosuppressant drug. Main outcome measures were (i) stability of vision, (ii) stability of inflammation and (iii) reduction of immunosuppressive load. Adverse events and reasons for stopping adalimumab were noted.
Seventeen patients from a single regional centre were included in the study. Nine patients had previously received an anti-TNF agent, and because of inefficacy, all were changed to adalimumab. At 12 months, fewer patients had visual acuity worse than LogMAR 0.4 (18% vs 32% at baseline). Using standardized uveitis nomenclature criteria, at 3 months, 50% of the patients eyes (n = 32) had improved, 16% had stable inflammation and 3% had worsened, whereas 31% were maintained with no anterior chamber cells. Six patients required courses of oral steroids for uveitis. Seven patients received intra- or periocular injections of steroids. Adalimumab treatment was interrupted in one patient because of varicella zoster infection. It was stopped in three patients. Seven (41%) patients reported injection site reactions.
In this group of children with refractory uveitis, use of adalimumab was associated with improvement in visual acuity and improving or stable ocular inflammation. However, it did not completely obviate the need for systemic or periocular steroid treatment. Prospective randomized controlled trials are required to help determine which subset of patients may benefit from adalimumab and the duration of treatment.
评估阿达木单抗在治疗难治性儿童非感染性慢性葡萄膜炎中的应用。
对接受皮质类固醇和另一种免疫抑制剂联合治疗失败后接受阿达木单抗治疗的葡萄膜炎患者进行病例队列干预研究。主要观察指标为（i）视力稳定性，（ii）炎症稳定性和（iii）免疫抑制负荷降低。记录不良事件和停止使用阿达木单抗的原因。
研究纳入了来自单一地区中心的 17 名患者。9 名患者先前接受过抗 TNF 药物治疗，由于疗效不佳，均改用阿达木单抗。12 个月时，视力低于 LogMAR 0.4 的患者比例（18%比基线时的 32%）更低。根据标准化葡萄膜炎命名法标准，3 个月时，50%的患者（n = 32）眼部情况改善，16%的患者炎症稳定，3%的患者恶化，而 31%的患者前房细胞无增加。6 名患者因葡萄膜炎需要口服类固醇治疗。7 名患者接受了眼内或眼周注射类固醇。因带状疱疹感染，1 名患者中断了阿达木单抗治疗。有 3 名患者停止使用该药。7（41%）名患者报告有注射部位反应。
在这组难治性葡萄膜炎儿童中，使用阿达木单抗与视力提高和改善或稳定的眼部炎症相关。然而，它并没有完全消除对全身或眼周类固醇治疗的需求。需要进行前瞻性随机对照试验，以帮助确定哪些亚组患者可能受益于阿达木单抗治疗以及治疗的持续时间。
