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非传染性免疫介导性葡萄膜炎的免疫治疗展望。

Perspectives for immunotherapy in noninfectious immune mediated uveitis.

机构信息

Department of Ophthalmology, DHU ViewRestore, Sorbonne Université, Paris, France.

Department of Ophthalmology Charles Nicolle University Hospital, Rouen, France.

出版信息

Expert Rev Clin Immunol. 2021 Sep;17(9):977-989. doi: 10.1080/1744666X.2021.1956313. Epub 2021 Jul 26.

Abstract

: Noninfectious uveitis (NIU) is one of the leading causes of blindness worldwide. In adult patients, anterior NIU is usually managed with topical corticosteroids. In intermediate, posterior uveitis. and panuveitis, systemic corticosteroids are used especially in case of bilaterality or association with systemic disease. Biotherapies are recommended in case of inefficacy or intolerance to corticosteroids or conventional immunosuppressive drugs. Anti-TNF-α agents are by far the most widely used biotherapies. In case of failure or poor tolerance to anti-TNF-α, new targeted therapies can be proposed.: We present and discuss an updated overview on biologics and biotherapies in NIU.: In case of dependency to systemic or intravitreal steroids, sight-threatening disease, and/or failure of conventional immunosuppressive drugs, anti-TNF-α are used as first-line biologics to achieve quiescence of inflammation. Anti-interleukin-6 is another option that may be proposed as first-line biologic or in case of poor efficacy of anti-TNF-α. Interferon can be directly proposed in specific indications (e.g. refractory macular edema, sight-threatening Behçet's uveitis). In the rare cases that remain unresponsive to traditional biotherapies, novel molecules, such as Janus-associated-kinase and anti-phosphodiesterase-4-inhibitors can be used. Therapeutic response must always be evaluated by clinical and appropriate ancillary investigations.

摘要

非感染性葡萄膜炎(NIU)是全球导致失明的主要原因之一。在成年患者中,通常采用局部皮质类固醇治疗前葡萄膜炎。对于中间、后葡萄膜炎和全葡萄膜炎,尤其是在双侧或伴有全身疾病的情况下,使用全身皮质类固醇。在对皮质类固醇或常规免疫抑制药物无效或不耐受的情况下,推荐使用生物疗法。在抗 TNF-α 药物治疗失败或不耐受的情况下,可以提出新的靶向治疗。

我们介绍并讨论了葡萄膜炎中生物制剂和生物疗法的最新概述。

对于依赖全身或玻璃体内类固醇、威胁视力的疾病和/或常规免疫抑制药物治疗失败的患者,使用抗 TNF-α 作为一线生物制剂来实现炎症静止。抗白细胞介素 6 是另一种可能被提议作为一线生物制剂的选择,或在抗 TNF-α 疗效不佳的情况下使用。在特定情况下(如难治性黄斑水肿、威胁视力的 Behçet 葡萄膜炎),可以直接提出使用干扰素。在极少数对传统生物疗法无反应的情况下,可以使用新型分子,如 Janus 相关激酶和磷酸二酯酶 4 抑制剂。必须通过临床和适当的辅助检查来评估治疗反应。

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