The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
Departments of Internal Medicine and Immunology, Section Clinical Immunology, Erasmus MC, Rotterdam, the Netherlands.
Acta Ophthalmol. 2019 Aug;97(5):451-459. doi: 10.1111/aos.14048. Epub 2019 Feb 7.
IgG4-related disease (IgG4-RD) is an immune-mediated systemic fibro inflammatory disease. Treatment of IgG4-related orbital disease (IgG4-ROD) is often indicated to relieve the symptoms and to prevent complications. For IgG4-ROD, no international formal treatment guidelines are available and the optimal treatment strategy is uncertain. In this systematic review, we describe the efficacy of conventional and biologic disease-modifying antirheumatic drugs (DMARDs) in IgG4-ROD. A systematic search of Embase, Medline, Web-of-Science, PubMed publisher, Cochrane and Google Scholar was performed for treatment outcomes in IgG4-ROD. Relevant articles on treatment of IgG4-ROD were retrieved to last date of inclusion 3 January 2018. The following inclusion criteria were used: articles in English or English translation, studies evaluating the use of DMARDs (conventional and biologic) in the treatment of IgG4-ROD. Meta-analysis and review articles were excluded. A final selection after full-text evaluation was made by independent reviewers, based on treatment of IgG4-ROD with DMARDs and the availability of treatment outcomes. With this systematic review, we identified 35 studies and case reports/series on IgG4-ROD, describing 95 patients, treated with conventional and/or biologic DMARDs. The success of conventional DMARDs varies between 36% and 75% in patients with IgG4-ROD, while rituximab is successful in the majority (93%) of the patients. Based on this systematic review, rituximab is the most effective DMARD in IgG4-ROD, while the efficacy of conventional DMARDs is limited. We propose early initiation of rituximab in case of refractory and organ- or life-threatening disease.
IgG4 相关疾病（IgG4-RD）是一种免疫介导的系统性纤维炎症性疾病。治疗 IgG4 相关眼眶疾病（IgG4-ROD）通常是为了缓解症状和预防并发症。对于 IgG4-ROD，目前尚无国际正式的治疗指南，最佳治疗策略尚不确定。在本系统评价中，我们描述了常规和生物疾病修饰抗风湿药物（DMARDs）在 IgG4-ROD 中的疗效。对 Embase、Medline、Web-of-Science、PubMed 出版商、Cochrane 和 Google Scholar 进行了系统检索，以获取 IgG4-ROD 的治疗结果。检索了有关 IgG4-ROD 治疗的相关文章，检索截止日期为 2018 年 1 月 3 日。使用的纳入标准为：英文或英文翻译的文章，评估 DMARDs（常规和生物）在 IgG4-ROD 治疗中的使用的研究。排除了荟萃分析和综述文章。独立评审员根据 DMARDs 治疗 IgG4-ROD 和治疗结果的可用性，对全文评估后进行最终选择。通过本系统评价，我们确定了 35 项 IgG4-ROD 的研究和病例报告/系列，描述了 95 例患者，接受了常规和/或生物 DMARDs 的治疗。在 IgG4-ROD 患者中，常规 DMARDs 的成功率在 36%至 75%之间，而利妥昔单抗在大多数（93%）患者中是成功的。基于本系统评价，利妥昔单抗是 IgG4-ROD 中最有效的 DMARD，而常规 DMARDs 的疗效有限。我们建议在难治性和危及器官或生命的疾病中早期开始使用利妥昔单抗。
