Cabane L, Baillif S, Baldin B, Breuil V, Euller-Ziegler L, Tieulié N
Service de rhumatologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France.
Service d'ophtalmologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France.
J Fr Ophtalmol. 2018 Apr;41(4):350-356. doi: 10.1016/j.jfo.2017.11.012. Epub 2018 Apr 13.
To report the characteristics of uveitis cases occurring while on biologic therapy or disease-modifying antirheumatic drugs (DMARDs) reported to the French national pharmacovigilance database.
All the uveitis cases occurring in patients with chronic rheumatologic diseases, chronic inflammatory intestinal diseases or connective tissue diseases, while treated with DMARDs and/or biologic therapies between 2000 and 2015 and reported to the French National Pharmacovigilance Database were collected.
During the study period, 32 cases of uveitis were reported (15 men, 17 women). Two patients were treated with one DMARD alone, 24 with biologic therapy alone, and six with both treatments. Anterior uveitis was diagnosed in 19 patients (8 cases were bilateral); intermediate uveitis was found (unilaterally) in one patient; posterior and diffuse uveitis occurred in 5 and 2 cases respectively. Five cases were inconclusive with regard to the anatomical type of uveitis. The uveitis was of infectious origin in 5 cases: 2 toxoplasmosis, 2 herpes virus and 1 tuberculosis. In the 27 other cases, it was not possible to state whether the uveitis was associated with the underlying disease (uncontrolled) or a side effect of the biologic/DMARD treatments. The occurrence of the uveitis led to 9 switches in biologic therapy and 13 discontinuations of treatment (8 complete discontinuations, 5 discontinuations only until uveitis remission was obtained). In 4 cases, the treatments were not modified. The database does not specify the ultimate course or rheumatologic disease activity at the time of the uveitis.
The presence of uveitis while on biologic therapy must not be taken to indicate a therapeutic failure, especially if the ocular manifestation is isolated. In the case of uveitis occurring in patients treated with biologic therapies and/or DMARDs, infectious complications should be ruled out.
报告向法国国家药物警戒数据库上报的在接受生物疗法或改善病情抗风湿药（DMARDs）治疗期间发生葡萄膜炎病例的特征。
收集2000年至2015年间在接受DMARDs和/或生物疗法治疗的慢性风湿性疾病、慢性炎症性肠病或结缔组织病患者中发生且上报至法国国家药物警戒数据库的所有葡萄膜炎病例。
在研究期间，共上报了32例葡萄膜炎病例（男性15例，女性17例）。2例患者仅接受一种DMARD治疗，24例仅接受生物疗法治疗，6例同时接受两种治疗。19例患者被诊断为前葡萄膜炎（8例为双侧）；1例患者被发现患有中间葡萄膜炎（单侧）；后葡萄膜炎和弥漫性葡萄膜炎分别发生5例和2例。5例葡萄膜炎的解剖类型不明确。5例葡萄膜炎为感染性病因：2例弓形虫病，2例疱疹病毒感染，1例结核病。在其他27例病例中，无法确定葡萄膜炎是与基础疾病（未得到控制）相关还是生物制剂/DMARD治疗的副作用。葡萄膜炎的发生导致9例生物疗法更换和13例治疗中断（8例完全中断，5例仅在葡萄膜炎缓解前中断）。4例患者的治疗未改变。数据库未明确葡萄膜炎发生时的最终病程或风湿性疾病活动情况。
接受生物疗法时出现葡萄膜炎不一定表明治疗失败，特别是如果眼部表现为孤立性时。对于接受生物疗法和/或DMARDs治疗的患者发生葡萄膜炎的情况，应排除感染性并发症。
