巨细胞动脉炎患者接受托珠单抗治疗后出现视力丧失。
Vision loss in patients with giant cell arteritis treated with tocilizumab.
机构信息
Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
出版信息
Arthritis Res Ther. 2021 Mar 22;23(1):92. doi: 10.1186/s13075-021-02480-4.
OBJECTIVES
Giant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ.
METHODS
In this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical, and laboratory data were analyzed.
RESULTS
A total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed by magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6-17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0-8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p = 0.032), had a lower C-reactive protein (p = 0.002), and showed a negative association with MRA of the aorta (p = 0.006). Two patients (1.1%) developed vision loss, both at the initiation of TCZ treatment.
CONCLUSION
Our data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at the initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether a shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.
目的
巨细胞动脉炎（GCA）可导致视力丧失。尚不清楚托珠单抗（TCZ）在多大程度上能够预防视力丧失。本研究旨在分析接受 TCZ 治疗的大型 GCA 患者队列中视力丧失的发生情况。
方法
在这项观察性单中心研究中，研究了 2010 年至 2018 年间接受 TCZ 治疗的 GCA 患者。分析了人口统计学、临床和实验室数据。
结果
共纳入 186 例患者（62%为女性）；109 例（59%）符合美国风湿病学会（ACR）标准，123 例（66%）患者经磁共振血管造影（MRA）诊断为大血管血管炎。TCZ 治疗的累积时间为 224 年，中位治疗时间为 11.1（IQR 5.6-17.9）个月。中位时间为 5.8（IQR 3.0-8.5）个月逐渐减少糖皮质激素（GC）的剂量。基线时有 70 例（38%）患者出现视觉症状，21 例（11%）患者出现视力丧失。基线时有视力丧失的患者年龄更大（p=0.032），C 反应蛋白水平更低（p=0.002），且与主动脉 MRA 呈负相关（p=0.006）。有 2 例（1.1%）患者在开始 TCZ 治疗时出现视力丧失。
结论
我们的数据显示，TCZ 治疗的患者视力丧失发生率非常低。2 例 AION 发生在开始治疗时，支持了这样一种假说，即动脉的晚期和已建立的结构变化是导致这种意外的关键因素。同时接受 GC 治疗的时间较短是否对视神经病变的风险有影响，这需要进一步研究。
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