Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts.
Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Ophthalmology. 2014 Jan;121(1):358-364. doi: 10.1016/j.ophtha.2013.07.019. Epub 2013 Sep 4.
To establish the safety and efficacy of infliximab for the treatment of refractory noninfectious uveitis.
Retrospective, interventional, noncomparative cohort study.
Eighty-eight patients from a single-center private practice.
Patients with chronic, recalcitrant uveitis treated with infliximab (Remicade; Janssen Biotech, Inc., Titusville, NJ) were identified through an electronic medical record database. All charts were reviewed for sex, diagnosis, location of inflammation, presence of vasculitis, prior immunomodulatory treatments, duration of infliximab treatment, dose received, secondary side effects, and other medications continued while receiving treatment with infliximab.
The primary outcome measures were the rate of remission, time to remission, relapse rate, failure rate, and patient tolerance. Additional analysis aimed to identity risk factors that would predict a higher success rate of infliximab to treat various types of noninfectious uveitis.
Of the 72 patients (81.8%) who achieved clinical remission while being treated with infliximab, 42 (58.3%) required additional immunomodulatory medications. At 7, 18.1, and 44.7 weeks, 25%, 50%, and 75% of patients, respectively, achieved clinical remission off all corticosteroids. Thirty-two patients (36.4%) experienced at least 1 side effect while on infliximab therapy, and 17 patients (19.3%) discontinued treatment secondary to 1 or more intolerable side effects. The most common adverse effects were skin rash (9.1%) and fatigue (8%). Factors associated with a higher chance to achieve clinical remission were nonidiopathic uveitis (P < 0.001), intermediate or panuveitis (P < 0.001), absence of vasculitis (P < 0.001), and a starting dose ≥5 mg/kg (P < 0.011).
Infliximab induces a high rate of complete clinical remission in recalcitrant uveitis and is well tolerated by most patients.
评估英夫利昔单抗治疗难治性非感染性葡萄膜炎的安全性和有效性。
回顾性、干预性、非对照队列研究。
单中心私人诊所的 88 例患者。
通过电子病历数据库确定接受英夫利昔单抗（Remicade；Janssen Biotech，Inc.，Titusville，NJ）治疗的慢性、难治性葡萄膜炎患者。所有图表均进行了性别、诊断、炎症部位、血管炎存在情况、既往免疫调节治疗、英夫利昔单抗治疗持续时间、剂量、继发性副作用以及接受英夫利昔单抗治疗时继续使用的其他药物等方面的评估。
主要观察指标为缓解率、缓解时间、复发率、失败率和患者耐受性。进一步分析旨在确定预测英夫利昔单抗治疗各种类型非感染性葡萄膜炎成功率较高的危险因素。
在接受英夫利昔单抗治疗的 72 例（81.8%）患者中，有 42 例（58.3%）需要额外的免疫调节药物。在第 7、18.1 和 44.7 周时，分别有 25%、50%和 75%的患者完全停用皮质类固醇后达到临床缓解。32 例（36.4%）患者在接受英夫利昔单抗治疗期间至少出现 1 种副作用，17 例（19.3%）因 1 种或多种无法耐受的副作用而停止治疗。最常见的不良反应是皮疹（9.1%）和疲劳（8%）。与更高临床缓解率相关的因素是非特发性葡萄膜炎（P<0.001）、中间型或全葡萄膜炎（P<0.001）、无血管炎（P<0.001）和起始剂量≥5mg/kg（P<0.011）。
英夫利昔单抗可诱导难治性葡萄膜炎获得较高的完全临床缓解率，且大多数患者对此具有良好的耐受性。
