Santos-Gómez Montserrat, Calvo-Río Vanesa, Blanco Ricardo, Beltrán Emma, Mesquida Marina, Adán Alfredo, Cordero-Coma Miguel, García-Aparicio Ángel M, Valls Pascual Elia, Martínez-Costa Lucía, Hernández María Victoria, Hernandez Garfella Marisa, González-Vela María C, Pina Trinitario, Palmou-Fontana Natalia, Loricera Javier, Hernández José L, González-Gay Miguel A
Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
Rheumatology and Ophthalmology, Hospital General Universitario de Valencia, Spain.
Clin Exp Rheumatol. 2016 Sep-Oct;34(6 Suppl 102):S34-S40. Epub 2016 Apr 7.
To assess the efficacy of other biologic therapies, different from infliximab (IFX) and adalimumab (ADA), in patients with Behçet's disease uveitis (BU).
Multicenter study of 124 patients with BU refractory to at least one standard immunosuppressive agent that required IFX or ADA therapy. Patients who had to be switched to another biologic agent due to inefficacy or intolerance to IFX or ADA or patient's decision were assessed. The main outcome measures were the degree of anterior and posterior chamber inflammation and macular thickness.
Seven (5.6%) of 124 cases (4 women/3 men; mean age, 43 (range 28- 67) years; 12 affected eyes) were studied. Five of them had been initially treated with ADA and 2 with IFX. The other biologic agents used were golimumab (n=4), tocilizumab (n=2) and rituximab (n=1). The ocular pattern was panuveitis (n=4) or posterior uveitis (n=3). Uveitis was bilateral in 5 patients (71.4%). At baseline, anterior chamber and vitreous inflammation were present in 6 (50%) and 7 (58.3%) of the eyes. All the patients (12 eyes) had macular thickening (OCT>250μm) and 4 of them (7 eyes), cystoid macular edema (OCT>300 μm). Besides reduction anterior chamber and vitreous inflammation, we observed a reduction of OCT values, from 330.4±58.5 μm at the onset of the biological agent to 273±50 μm at month 12 (p=0.06). Six patients achieved a complete remission of uveitis.
The vast majority of patients with BU refractory to standard immunosuppressive drugs are successfully controlled with ADA and/or IFX. Other biologic agents appear to be also useful.
评估不同于英夫利昔单抗（IFX）和阿达木单抗（ADA）的其他生物疗法对贝赫切特病葡萄膜炎（BU）患者的疗效。
对124例对至少一种需要IFX或ADA治疗的标准免疫抑制剂难治的BU患者进行多中心研究。对因IFX或ADA无效或不耐受或患者决定而不得不改用另一种生物制剂的患者进行评估。主要观察指标为前房和后房炎症程度以及黄斑厚度。
研究了124例中的7例（5.6%）（4例女性/3例男性；平均年龄43岁（范围28 - 67岁）；12只患眼）。其中5例最初接受ADA治疗，2例接受IFX治疗。使用的其他生物制剂为戈利木单抗（n = 4）、托珠单抗（n = 2）和利妥昔单抗（n = 1）。眼部类型为全葡萄膜炎（n = 4）或后葡萄膜炎（n = 3）。5例患者（71.4%）葡萄膜炎为双侧。基线时，6只眼（50%）存在前房炎症，7只眼（58.3%）存在玻璃体炎症。所有患者（12只眼）均有黄斑增厚（光学相干断层扫描（OCT）>250μm），其中4例（7只眼）有黄斑囊样水肿（OCT>300μm）。除了前房和玻璃体炎症减轻外，我们观察到OCT值从生物制剂开始使用时的330.4±58.5μm降至第12个月时的273±50μm（p = 0.06）。6例患者葡萄膜炎完全缓解。
绝大多数对标准免疫抑制药物难治的BU患者通过ADA和/或IFX得到成功控制。其他生物制剂似乎也有用。
