Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria.
Department of Ophthalmology, Medical University Graz, Graz, Austria.
Pediatr Rheumatol Online J. 2021 Aug 21;19(1):132. doi: 10.1186/s12969-021-00630-1.
To assess the efficacy of golimumab (GLM) as a treatment option for juvenile idiopathic arthritis (JIA)-associated uveitis refractory to adalimumab (ADA).
Retrospective single-centre study including patients with JIA receiving GLM for active uveitis after failing ADA. JIA- and uveitis-related data, including intraocular inflammation, best-corrected visual acuity, corticosteroid-sparing potential, and ocular complications were evaluated at start of GLM treatment, at 1 month and 3 months, and every 3 months thereafter during GLM administration. We further investigated the association of response to GLM with primary and secondary failure of ADA treatment.
Ten patients were studied, all female (17 affected eyes, mean age 14.3 + 6.7 yrs., mean follow-up 25.2 + 21.7 mos). Two patients were switched to GLM because of primary non-response to ADA. Eight were switched because of loss of response (LOR). In 5 of the latter LOR was associated with neutralizing anti-ADA-antibodies. Response to GLM was observed in all 8 patients with LOR, while the 2 patients with primary non-response to ADA also did not respond to GLM. Three of the 8 responders experienced LOR. At the end of follow-up 4 of the 5 remaining responders had achieved complete response. One had achieved partial response.
GLM is an efficacious therapeutic option in patients who experience LOR to ADA. Our data indicate that patients without primary response to ADA should be rather switched to a biologic agent with a different mode of action instead of further blocking the TNF-alpha pathway.
评估戈利木单抗（GLM）作为治疗对阿达木单抗（ADA）治疗反应不佳的幼年特发性关节炎（JIA）相关葡萄膜炎的疗效。
这是一项回顾性单中心研究，纳入了 JIA 患者，这些患者在 ADA 治疗失败后接受 GLM 治疗活动期葡萄膜炎。在开始 GLM 治疗时、1 个月和 3 个月以及此后每 3 个月评估 JIA 和葡萄膜炎相关数据，包括眼内炎症、最佳矫正视力、皮质类固醇节省潜力和眼部并发症。我们进一步研究了对 GLM 的反应与 ADA 治疗的原发性和继发性失败的相关性。
共纳入 10 名患者（17 只患眼，平均年龄 14.3±6.7 岁，平均随访 25.2±21.7 个月）。2 名患者因 ADA 原发性无反应而转为 GLM。8 名患者因失去反应（LOR）而转为 GLM。后者中，5 例 LOR 与中和抗 ADA 抗体有关。在 8 例 LOR 患者中均观察到对 GLM 的反应，而 2 例对 ADA 原发性无反应的患者也未对 GLM 产生反应。8 例反应者中有 3 例出现 LOR。在随访结束时，5 名持续反应者中有 4 名达到完全反应，1 名达到部分反应。
GLM 是治疗对 ADA 治疗出现 LOR 的患者的有效治疗选择。我们的数据表明，对 ADA 无原发性反应的患者应改用作用机制不同的生物制剂，而不是进一步阻断 TNF-α 通路。
