Strianese Diego
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia and Department of Neuroscience, Reproductive Sciences and Dentistry - University of Naples Federico II, Naples, Italy.
Ophthalmic Plast Reconstr Surg. 2018 Jul/Aug;34(4S Suppl 1):S56-S59. doi: 10.1097/IOP.0000000000001131.
To present an update on the efficacy and safety of immunosuppressive therapy for thyroid eye disease (TED) and to offer a general recommendation for management of TED, in light of these reports.
Data were retrieved from a literature search on PubMed, using the following words: thyroid eye disease, immunosuppressant, corticosteroid, methotrexate, azathioprine, cyclosporine, cyclophosphamide, rituximab, etanercept, adalimumab, tocilizumab, teprotumumab, adverse effects, side effects, and complications.
Corticosteroids continue to be the primary medical therapy for TED. Recent research has offered insight into potential differences between oral corticosteroid and intravenous corticosteroid treatment regimens in terms of efficacy and side-effect profiles, which proved more favorable for the latter. The use of some traditional immunosuppressive agents, such as methotrexate and mycophenolate, seems suitable as steroid-sparing medications. In recent years, many scientific reports demonstrated the effectiveness of biologic immunosuppressive agents in the management of TED. Etanercept, adalimumab, and tocilizumab have been shown to be effective in reduction of the inflammatory signs with the possible added advantage of preventing relapse of the disease. Teprotumumab may control the disease activity, and it seems to be very effective in preventing disease progression. Infliximab might be useful in severe TED resistant to steroids and orbital decompression.
Steroid therapy remains the first-line therapy for moderate/severe and severe vision-threatening TED. The biological agents may provide a deep and long-standing block of inflammatory activity in TED, with the hope to lower the risk of recurrences and to reduce the need of surgical intervention in moderate-to-severe disease. Indeed, the actual incidence of adverse effects is not yet well assessed because of the paucity of studies. Therefore, their use should be limited to those cases that really need an alternative therapy to steroids, handled by expert physician in this field.
根据这些报告，介绍甲状腺眼病（TED）免疫抑制治疗的疗效和安全性的最新情况，并为TED的管理提供一般性建议。
通过在PubMed上进行文献检索获取数据，检索词如下：甲状腺眼病、免疫抑制剂、皮质类固醇、甲氨蝶呤、硫唑嘌呤、环孢素、环磷酰胺、利妥昔单抗、依那西普、阿达木单抗、托珠单抗、替普罗单抗、不良反应、副作用和并发症。
皮质类固醇仍然是TED的主要药物治疗方法。最近的研究揭示了口服皮质类固醇和静脉注射皮质类固醇治疗方案在疗效和副作用方面的潜在差异，结果表明后者更具优势。使用一些传统免疫抑制剂，如甲氨蝶呤和霉酚酸酯，似乎适合作为类固醇节省药物。近年来，许多科学报告证明了生物免疫抑制剂在TED管理中的有效性。依那西普、阿达木单抗和托珠单抗已被证明可有效减轻炎症体征，可能还有预防疾病复发的额外优势。替普罗单抗可以控制疾病活动，并且似乎在预防疾病进展方面非常有效。英夫利昔单抗可能对抵抗类固醇和眼眶减压的严重TED有用。
类固醇疗法仍然是中度/重度和严重威胁视力的TED的一线治疗方法。生物制剂可能会在TED中提供深度和长期的炎症活动阻断作用，有望降低复发风险并减少中重度疾病的手术干预需求。事实上，由于研究较少，不良反应的实际发生率尚未得到很好的评估。因此，它们的使用应限于那些真正需要替代类固醇疗法的病例，由该领域的专家医生处理。
