Mili-Boussen Ilhem, Zitouni Monia, Ammous Imen, Letaief Imene, Errais Khalil, Zhioua Raja, Khalfallah Narjesse
Tunis Med. 2015 Mar;93(3):158-63.
the systemic steroids represent the first line treatment in the majority of the noninfectious uveitis, except some specific indications as the Behcet disease. Nevertheless, this treatment may be ineffective and immunosuppressive therapy is mandatory.
to evaluate effectiveness and side effects of azathioprine (AZA) in corticosteroid resistant noninfectious uveitis (CRNIU).
This prospective study (2002- 2009), concerned 21 patients (mean age 37 years), 37 eyes, with CRNIU. Patients received oral AZA 2,5mg/kg/day, initiated in association with high dose steroids, with an end-point of 12 months. Response was defined as complete, partial response and failure, for each of the 3 following out-come measurements: improvement of BCVA, improvement of inflammation, steroids-sparing. Statistical analysis was considered significant if p value < 0,05.
side effects occurred in 42,8% (9/21) of patients, in which 5/9 patients stopped the treatment. Regarding BCVA, complete success was observed in 62,5%, partial response in 20,9% , and failure in 16,6% of cases. Regarding inflammation, complete success was noted in 70,8%, partial response in 29,1% and failure in 16,6 % of cases. Complete response of steroid sparing was observed in 85,7% of cases without failure. Complete success of the 3 criteria was observed in 57,1% of patients / 62,5% of eyes. Cataract (p=0,013) and pallor of optic nerve head (p=0,013) were associated to poor visual prognosis, BCVA of 20/40 or more (p=0,003, RR=2,38)) and papilledema (p=0,022, RR=2) to good visual prognosis. BCVA of 20/200 or less (p=0,001) was associated to failure of AZA on inflammatory response.
AZA is safe and effective in corticosteroid-sparing and controlling inflammation in CRNIU. Its low cost and availability allow proposing it as a first-line option, especially when new biological treatments are difficult to obtain.
除白塞病等一些特定指征外，全身用类固醇是大多数非感染性葡萄膜炎的一线治疗方法。然而，这种治疗可能无效，免疫抑制治疗是必要的。
评估硫唑嘌呤（AZA）在皮质类固醇抵抗性非感染性葡萄膜炎（CRNIU）中的有效性和副作用。
这项前瞻性研究（2002 - 2009年）涉及21例（平均年龄37岁）患有CRNIU的患者，共37只眼。患者接受口服AZA 2.5mg/kg/天，与高剂量类固醇联合使用，终点为12个月。对于以下3项结果测量中的每一项，反应被定义为完全缓解、部分缓解和失败：最佳矫正视力（BCVA）改善、炎症改善、类固醇减量。如果p值<0.05，则认为统计分析具有显著性。
42.8%（9/21）的患者出现副作用，其中5/9的患者停止治疗。关于BCVA，62.5%的病例观察到完全成功，20.9%为部分缓解，16.6%为失败。关于炎症，70.8%的病例观察到完全成功，29.1%为部分缓解，16.6%为失败。85.7%的病例观察到类固醇减量的完全反应，无失败情况。57.1%的患者/62.5%的眼睛观察到3项标准的完全成功。白内障（p = 0.013）和视神经乳头苍白（p = 0.013）与不良视力预后相关，BCVA为20/40或更好（p = 0.003，相对危险度RR = 2.38）和视乳头水肿（p = 0.022，RR = 2）与良好视力预后相关。BCVA为20/200或更低（p = 0.001）与AZA对炎症反应失败相关。
AZA在CRNIU中类固醇减量和控制炎症方面是安全有效的。其低成本和可得性使其可作为一线选择，特别是在难以获得新的生物治疗方法时。
