Castiblanco Claudia, Meese Halea, Foster C Stephen
Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation (OIUF), Waltham, Massachusetts.
Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation (OIUF), Waltham, Massachusetts; Harvard Medical School, Boston, Massachusetts.
J AAPOS. 2016 Apr;20(2):145-7. doi: 10.1016/j.jaapos.2015.12.006.
To evaluate adalimumab therapy in children with uveitis.
The electronic health records of pediatric patients diagnosed with uveitis and treated with adalimumab therapy were reviewed retrospectively. Demographic information, site and degree of intraocular inflammation, visual acuity, underlying systemic disorders, duration of therapy, side effects, and ability to obtain steroid-free remission were recorded.
A total of 17 patients were included, 16 patients with anterior uveitis and 1 with panuveitis; 14 patients had bilateral disease. Juvenile idiopathic arthritis had been diagnosed in 14 patients, sarcoidosis in 1 patient, and idiopathic etiology in 2 patients. Of the 17 patients, 13 (about 77%) achieved steroid-free remission, and 4 did not. Six patients flared after discontinuation of adalimumab, with evidence of inflammation noted 3-7 months later. Adalimumab therapy was of 12-64 months' duration (mean, 36 months). At the time of initiation, 14 patients were using other agents concomitantly with adalimumab; 3 patients were on adalimumab monotherapy. At 1 year's follow-up, 12 patients were using combination therapy, and 3 patients were on adalimumab monotherapy: 11 patients had no evidence of inflammation. Side effects included pain at site of injection in 3 patients, anemia in 1 patient, and depression in 1 patient.
In our study cohort, adalimumab was effective in inducing steroid-free remission. It was well tolerated, especially in combination with other immunomodulatory agents. The dosing and the interval can be adjusted to further improve inflammation control.
评估阿达木单抗治疗儿童葡萄膜炎的效果。
回顾性分析诊断为葡萄膜炎并接受阿达木单抗治疗的儿科患者的电子健康记录。记录人口统计学信息、眼内炎症的部位和程度、视力、潜在的全身疾病、治疗持续时间、副作用以及实现无类固醇缓解的能力。
共纳入17例患者，其中16例为前葡萄膜炎，1例为全葡萄膜炎；14例患者为双侧疾病。14例患者诊断为幼年特发性关节炎，1例为结节病，2例为特发性病因。17例患者中，13例（约77%）实现了无类固醇缓解，4例未实现。6例患者在停用阿达木单抗后病情复发，3 - 7个月后出现炎症迹象。阿达木单抗治疗持续时间为12 - 64个月（平均36个月）。开始治疗时，14例患者同时使用其他药物与阿达木单抗；3例患者接受阿达木单抗单药治疗。随访1年时，12例患者使用联合治疗，3例患者接受阿达木单抗单药治疗：11例患者无炎症迹象。副作用包括3例患者注射部位疼痛、1例患者贫血和1例患者抑郁。
在我们的研究队列中，阿达木单抗在诱导无类固醇缓解方面有效。耐受性良好，尤其是与其他免疫调节药物联合使用时。给药剂量和间隔可进行调整以进一步改善炎症控制。
