Internal Medicine Department, Hospital Charles Nicolle, Rouen, France.
Internal Medicine Department, Hospital Jacques Monod, Le Havre, France.
J Autoimmun. 2020 Sep;113:102481. doi: 10.1016/j.jaut.2020.102481. Epub 2020 Jun 23.
To compare the efficacy and safety of Disease-modifying antirheumatic drugs (DMARDs) and anti-TNF-α agents in patients with non-infectious non-anterior uveitis.
Single center retrospective study including adult patients with non-infectious intermediate, posterior or pan-uveitis. Outcomes were compared between patients treated with DMARDs or anti-TNF-α agents. The primary outcome was treatment failure or occurrence of serious adverse events. Treatment failure was determined by ophthalmologic criteria.
Seventy-three patients were included, mostly female (52%). Among them, 39 were treated with DMARDs and 34 with anti-TNF-α agents. The main uveitis causes were idiopathic (30%), birdshot chorio-retinopathy (25%), sarcoidosis (16%) and Behçet's disease (14%). The primary outcome was observed in 56% of patients treated with anti-TNF-α agents versus 59% of patients treated with DMARDs (p = 0.82). Median time to observe the primary outcome was 16 months (anti-TNF-α group) versus 21 months (p = 0.52). There was no significant difference between the two groups in terms of treatment failure, corticosteroid sparing effect, visual acuity improvement or adverse events. Earlier control of ocular inflammation was achieved with anti-TNF-α agents than with DMARDs (p = 0.006). In relapsing patients, anti-TNF-α agents allowed better corticosteroid sparing (p = 0.06).
DMARDs could still be used as first-line therapy for non-infectious non-anterior uveitis after corticosteroid therapy. However, anti-TNF-α agents could be proposed as an alternative in cases of severe inflammation or initial high level of steroid dependency.
比较疾病修饰抗风湿药物（DMARDs）和抗 TNF-α 制剂在非感染性非前葡萄膜炎患者中的疗效和安全性。
单中心回顾性研究纳入了非感染性中间、后或全葡萄膜炎的成年患者。比较了接受 DMARDs 或抗 TNF-α 制剂治疗的患者的结局。主要结局是治疗失败或发生严重不良事件。治疗失败根据眼科标准确定。
共纳入 73 例患者，大多数为女性（52%）。其中 39 例接受 DMARDs 治疗，34 例接受抗 TNF-α 制剂治疗。主要葡萄膜炎病因是特发性（30%）、鸟枪弹样脉络膜视网膜病变（25%）、结节病（16%）和 Behçet 病（14%）。抗 TNF-α 制剂组 56%的患者出现主要结局，DMARDs 组为 59%（p=0.82）。观察到主要结局的中位时间为抗 TNF-α 制剂组 16 个月，DMARDs 组为 21 个月（p=0.52）。两组在治疗失败、皮质类固醇节省效应、视力改善或不良事件方面无显著差异。抗 TNF-α 制剂较 DMARDs 更早控制眼部炎症（p=0.006）。在复发患者中，抗 TNF-α 制剂可更好地节省皮质类固醇（p=0.06）。
在皮质类固醇治疗后，DMARDs 仍可作为非感染性非前葡萄膜炎的一线治疗。然而，在炎症严重或初始皮质类固醇依赖性高的情况下，可考虑使用抗 TNF-α 制剂作为替代治疗。
