Bajwa Asima, Maleki Arash, Payal Abhishek R, Fandiño Adriana, Padrón María Inés Menéndez, Walsh Marisa, Foster C Stephen
Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts.
Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts.
J Ophthalmic Vis Res. 2020 Oct 25;15(4):459-469. doi: 10.18502/jovr.v15i4.7786. eCollection 2020 Oct-Dec.
To determine the efficacy and safety of infliximab therapy in patients with HLA B-27-associated ocular inflammation resistant or intolerant to conventional immunomodulatory therapy.
This was a retrospective observational case series. All cases were uveitic patients with positive HLA-B27, confirmed through HLA testing, resistant or intolerant to conventional immunomodulatory therapy. The primary outcome of the study was to identify the efficacy of infliximab determined by the control of inflammation, duration of remission, and the ability to reduce conventional immunomodulatory therapy. The secondary outcome was an improvement of two or more lines of best-corrected visual acuity (BCVA) on the Snellen visual acuity chart.
Twenty-four patients (38 eyes) were included in the study. All patients were followed for 24 months. Twenty-one (87.5%) patients completed 24 months of follow-up. Sixteen (66.7%) patients had active uveitis at the beginning of therapy. One patient out of these active patients had active inflammation at the end of follow-up period. Thirteen (87.5%) out of sixteen active patients were in steroid-free remission. The mean duration of treatment to induce remission was 16.5 months (range 6-24 months). Corticosteroid was stopped in 19 (90.5%) patients by the end of the study. At the end of the study, in patients who achieved remission, 14 (58.3%) patients were in remission on infliximab therapy and 6 (25%) patients were in remission off infliximab therapy. Of the 38 eyes, 8 (21.05%) showed improvement in BCVA (three eyes had successful cataract extraction with intraocular lens implantation during infliximab therapy with no subsequent inflammation), while 26 eyes (68.4%) had stable BCVA over the 24-month study period. The side effects included allergic reaction, fatigue, cellulitis, headache, restlessness, elevation of liver enzymes, and anemia. Two patients ( = 24, 8.3%) experienced severe adverse effects and the treatment was stopped prematurely in these two patients.
Infliximab might induce and maintain the steroid-free remission in HLA-B27-associated ocular inflammation in patients resistant or intolerant to conventional immunomodulatory therapy.
确定英夫利昔单抗治疗对常规免疫调节治疗耐药或不耐受的 HLA B-27 相关眼部炎症患者的疗效和安全性。
这是一项回顾性观察病例系列研究。所有病例均为 HLA-B27 阳性的葡萄膜炎患者，经 HLA 检测确诊，对常规免疫调节治疗耐药或不耐受。该研究的主要结局是通过炎症控制、缓解持续时间以及减少常规免疫调节治疗的能力来确定英夫利昔单抗的疗效。次要结局是在斯内伦视力表上最佳矫正视力（BCVA）提高两行或更多行。
本研究纳入了 24 例患者（38 只眼）。所有患者均随访 24 个月。21 例（87.5%）患者完成了 24 个月的随访。16 例（66.7%）患者在治疗开始时患有活动性葡萄膜炎。这些活动性患者中 1 例在随访期结束时仍有活动性炎症。16 例活动性患者中有 13 例（87.5%）处于无类固醇缓解状态。诱导缓解的平均治疗持续时间为 16.5 个月（范围 6 - 24 个月）。到研究结束时，19 例（90.5%）患者停用了皮质类固醇。在研究结束时，在实现缓解的患者中，14 例（58.3%）患者在接受英夫利昔单抗治疗时处于缓解状态，6 例（25%）患者在停用英夫利昔单抗治疗时处于缓解状态。在 38 只眼中，8 只眼（21.05%）的 BCVA 有所改善（3 只眼在英夫利昔单抗治疗期间成功进行了白内障摘除并植入人工晶状体，随后未发生炎症），而 26 只眼（68.4%）在 24 个月的研究期间 BCVA 稳定。副作用包括过敏反应、疲劳、蜂窝织炎、头痛、烦躁不安、肝酶升高和贫血。2 例患者（24 例中的 2 例，8.3%）出现严重不良反应，这 2 例患者的治疗提前终止。
英夫利昔单抗可能诱导并维持对常规免疫调节治疗耐药或不耐受的 HLA-B27 相关眼部炎症患者的无类固醇缓解。
