Department of Ophthalmology, Humanitas Clinical and Research Center, Milan, Italy.
Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Auto inflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, University of Siena, Siena, Italy.
Br J Ophthalmol. 2018 May;102(5):637-641. doi: 10.1136/bjophthalmol-2017-310733. Epub 2017 Aug 26.
BACKGROUND/AIMS: Adalimumab (ADA) has been shown to be an effective treatment for Behçet's disease (BD)-related uveitis. We aimed at evaluating the cumulative retention rate of ADA during a 48-month follow-up period in patients with BD-related uveitis, the impact of a concomitant use of disease modifying anti-rheumatic drugs (DMARDs) on ADA retention rate, and differences according to the various lines of biologic therapy (ie, first- vs second-line or more). Predictive factors of response to ADA were also investigated.
We enrolled patients diagnosed with BD-related uveitis and treated with ADA between January 2009 and December 2016. Cumulative survival rates were studied using the Kaplan-Meier plot, while the log-rank (Mantel-Cox) test was used to compare survival curves. Statistical analysis was performed to identify differences according to the response to ADA.
54 consecutive patients (82 eyes) were eligible for analysis. The drug retention rate at 12- and 48-month follow-up was 76.9% and 63.5%, respectively. No statistically significant differences were identified according to the use of concomitant DMARDs (p=0.27) and to the different lines of ADA treatment (p=0.37). No significant differences were found between patients continuing and discontinuing ADA in terms of age (p=0.24), age at BD onset (p=0.81), age at uveitis onset (p=0.56), overall BD duration (p=0.055), uveitis duration (p=0.46), human leucocyte antigen-B51 positivity (p=0.51), and gender (p=0.47).
ADA retention rate in BD-related uveitis is excellent and is not affected by the concomitant use of DMARDs or by the different lines of biological therapy. Negative prognostic factors for BD uveitis do not impact ADA efficacy.
背景/目的：阿达木单抗（ADA）已被证明对治疗贝赫切特病（BD）相关性葡萄膜炎有效。我们旨在评估 ADA 在 BD 相关性葡萄膜炎患者的 48 个月随访期间的累积保留率、同时使用疾病修正抗风湿药物（DMARDs）对 ADA 保留率的影响，以及根据不同的生物治疗线（即一线与二线或更多线）的差异。还研究了 ADA 反应的预测因素。
我们纳入了 2009 年 1 月至 2016 年 12 月期间接受 ADA 治疗的诊断为 BD 相关性葡萄膜炎的患者。使用 Kaplan-Meier 图研究累积生存率，对数秩（Mantel-Cox）检验用于比较生存曲线。进行统计分析以根据 ADA 反应确定差异。
54 例连续患者（82 只眼）符合分析条件。ADA 治疗 12 个月和 48 个月的药物保留率分别为 76.9%和 63.5%。同时使用 DMARDs（p=0.27）和 ADA 治疗的不同线数（p=0.37）之间没有统计学差异。在继续和停止使用 ADA 的患者之间，年龄（p=0.24）、BD 发病年龄（p=0.81）、葡萄膜炎发病年龄（p=0.56）、总 BD 持续时间（p=0.055）、葡萄膜炎持续时间（p=0.46）、人类白细胞抗原-B51 阳性（p=0.51）和性别（p=0.47）方面无显著差异。
ADA 在 BD 相关性葡萄膜炎中的保留率很高，不受同时使用 DMARDs 或不同的生物治疗线的影响。BD 葡萄膜炎的阴性预后因素不影响 ADA 的疗效。
