From the Department of Woman and Child Health, University of Padua, Padua; G. Pini Institute for Rheumatology; Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda, Ospedale Maggiore Policlinico, Milan; Department of Ophthalmology, Sapienza University; Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome; Institute for Maternal and Child Health IRCCS "Burlo Garofolo," Trieste; Anna Meyer Children's Hospital, and Department of Internal Medicine, Rheumatology, Transition Clinic, University of Florence, Florence; G. Gaslini Children's Hospital, Genoa; Department of Pediatrics, A. Perrino Hospital, Brindisi; Department of Neurosciences and Sense Organs, University of Bari, Bari; Ospedale Infantile Regina Margherita, University of Torino, Torino; Ophthalmology Unit, University Hospital Borgo Trento, Verona; IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
V. Cecchin, MD, Assistant Professor, Department of Woman and Child Health, University of Padua; M.E. Zannin, MD, Department of Woman and Child Health, University of Padua; D. Ferrari, MD, Assistant Professor, Department of Woman and Child Health, University of Padua; I. Pontikaki, MD, Assistant Professor, G. Pini Institute for Rheumatology, Milan; E. Miserocchi, MD, Assistant Professor, G. Pini Institute for Rheumatology; M.P. Paroli, MD, Assistant Professor, Department of Ophthalmology, Sapienza University; C. Bracaglia, MD, Assistant Professor, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù; D.P. Marafon, MD, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù; S. Pastore, MD, Rheumatology Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo"; F. Parentin, MD, Assistant Professor, Ophthalmology Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo"; G. Simonini, MD, Associate Professor, Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence; C. De Libero, MD, Ophthalmology Unit, Anna Meyer Children's Hospital, University of Florence; F. Falcini, MD, Associate Professor, Rheumatology Unit, Transition Clinic, University of Florence; A. Petaccia, MD, Assistant Professor, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico; G. Filocamo, MD, Assistant Professor, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico; R. De Marco, MD, Assistant Professor, Ophthalmology Unit, G. Gaslini Children's Hospital; F. La Torre, MD, Assistant Professor, Department of Pediatrics, A. Perrino Hospital; S. Guerriero, MD, Associate Professor, Department of Neurosciences and Sense Organs, University of Bari; S. Martino, MD, Associate Professor, Ospedale Infantile Regina Margherita, University of Torino; F. Comacchio, MD, Assistant Professor, Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Verona University Medical School, and University Hospital Borgo Trento; V. Muratore, MD, Assistant Professor, Department of Pediatrics, IRCCS Fondazione Policlinico San Matteo; G. Martini, MD, PhD, Assistant Professor, Department of Woman and Child Health, University of Padua; F. Vittadello, Department of Woman and Child Health, University of Padua; F. Zulian, MD, Associate Professor, Rheumatology Unit, Department of Woman and Child Health, University of Padua.
J Rheumatol. 2018 Aug;45(8):1167-1172. doi: 10.3899/jrheum.171006. Epub 2018 Apr 15.
Anti-TNF-α agents have significantly changed the management of juvenile idiopathic arthritis (JIA). We evaluated the safety and efficacy of adalimumab (ADA) and infliximab (IFX) for the treatment of JIA-associated uveitis in patients treated for ≥ 2 years.
Patients with JIA-associated uveitis treated with IFX and ADA were managed by a standardized protocol and data were entered in the ORCHIDEA registry. At baseline, all patients were refractory to standard immunosuppressive treatment or were corticosteroid-dependent. Data recorded every 3 months were uveitis course, number/type of ocular flares and complications, drug-related adverse events (AE), and treatment switch or withdrawal. Data of patients treated for ≥ 2 years were analyzed by descriptive statistics.
Up to December 2014, 154 patients with ≥ 24 months followup were included in the study. Fifty-nine patients were treated with IFX and 95 with ADA. Clinical remission, defined as the absence of flares for > 6 months on treatment, was achieved in 69 patients (44.8%), with a better remission rate for ADA (60.0%) as compared to IFX (20.3%; p < 0.001). A significant reduction of flares was observed in all patients without difference between the 2 treatment modalities. The number of new ocular complications decreased in both groups but was lower for ADA (p = 0.015). No serious AE were recorded; 16.4% of patients experienced 35 minor AE and the incidence rate was lower with ADA than with IFX.
At the 2-year followup, ADA showed a better efficacy and safety profile than IFX for the treatment of refractory JIA-associated uveitis.
抗 TNF-α 制剂显著改变了幼年特发性关节炎（JIA）的治疗方法。我们评估了阿达木单抗（ADA）和英夫利昔单抗（IFX）治疗 JIA 相关葡萄膜炎的安全性和疗效，这些患者的治疗时间≥2 年。
采用标准化方案治疗 JIA 相关葡萄膜炎的 IFX 和 ADA 治疗患者，并在 ORCHIDEA 注册登记处录入数据。基线时，所有患者对标准免疫抑制治疗均耐药或依赖皮质激素。每 3 个月记录一次的数据包括葡萄膜炎病程、眼部发作的次数/类型和并发症、药物相关不良事件（AE）、治疗转换或停药。≥2 年的患者数据采用描述性统计分析。
截至 2014 年 12 月，154 例患者的随访时间≥24 个月，纳入本研究。59 例患者接受 IFX 治疗，95 例患者接受 ADA 治疗。ADA 组（60.0%）的临床缓解率（无疾病活动期>6 个月）优于 IFX 组（20.3%）（p<0.001），69 例患者（44.8%）达到缓解。两种治疗方式均显著减少了发作次数，ADA 组无新发眼部并发症，IFX 组有 2 例（p=0.015）。未记录严重 AE；16.4%的患者出现 35 例轻微 AE，ADA 组的发生率低于 IFX 组。
在 2 年随访时，ADA 治疗 JIA 相关葡萄膜炎的疗效优于 IFX，安全性更好。
