Department of Ophthalmology, Humanitas Clinical and Research Centre, Rozzano, Milan; and Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
Research Centre of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Centre, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy.
Clin Exp Rheumatol. 2019 Mar-Apr;37(2):301-305. Epub 2019 Jan 18.
To assess the efficacy of monoclonal anti-tumour necrosis factor (TNF)-α agents in patients with anterior uveitis (AU) in terms of decrease of recurrences, variation of visual acuity and steroid sparing effect and to identify any demographic, clinical or therapeutic variables associated with a sustained response to monoclonal TNF-α inhibitors.
Data from patients suffering from AU treated with adalimumab, infliximab, golimumab or certolizumab pegol were retrospectively collected and statistically analysed.
Sixty-nine patients (22 males, 47 females), corresponding to 101 eyes, were enrolled. The mean follow-up period was 29.25±23.51 months. The rate of ocular flares decreased from 42.03 events/100 patients/year recorded during the 12 months preceding the start of TNF-α inhibitors to 2.9 flares/100 patients/year after the start of treatment (p<0.0001). The overall decrease in ocular flares was 93.1%. No statistically significant changes were identified in the best corrected visual acuity during the follow-up period (p>0.99). The number of patients treated with corticosteroids at baseline was significantly higher compared with that referred to the 12-month evaluation (p<0.001) and to the last follow-up visit (p=0.006). Concomitant treatment with conventional disease-modifying anti-rheumatic drugs (cDMARDs) represented the sole clinical, demographic or therapeutic variable associated with long-term treatment duration (p=0.045, R2=0.87).
Monoclonal TNF-α inhibitors induce a remarkable decrease in the recurrence of AU during a long-term follow-up period and lead to a significant steroid sparing effect along with stabilisation of visual acuity. Concomitant treatment with cDMARDs represented the sole variable associated with treatment duration in the long-term.
评估单克隆抗肿瘤坏死因子（TNF）-α 药物在治疗前葡萄膜炎（AU）患者中的疗效，包括降低复发率、视力变化和类固醇节省效应，并确定与单克隆 TNF-α 抑制剂持续反应相关的任何人口统计学、临床或治疗相关变量。
回顾性收集并统计分析接受阿达木单抗、英夫利昔单抗、戈利木单抗或培塞利珠单抗治疗的 AU 患者的数据。
共纳入 69 例（22 例男性，47 例女性）101 只眼患者。平均随访时间为 29.25±23.51 个月。在开始使用 TNF-α 抑制剂前 12 个月，眼部发作率为 42.03 例/100 例/年，而治疗后下降至 2.9 例/100 例/年（p<0.0001）。眼部发作总体减少了 93.1%。在随访期间，最佳矫正视力无明显变化（p>0.99）。基线时接受皮质类固醇治疗的患者数量明显高于 12 个月评估时（p<0.001）和最后一次随访时（p=0.006）。同时使用传统的疾病修饰抗风湿药物（cDMARDs）是与长期治疗持续时间相关的唯一临床、人口统计学或治疗相关变量（p=0.045，R2=0.87）。
单克隆 TNF-α 抑制剂在长期随访期间可显著降低 AU 的复发率，并具有显著的类固醇节省效应，同时稳定视力。同时使用 cDMARDs 是与长期治疗持续时间相关的唯一变量。
