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英夫利昔单抗治疗难治性非感染性葡萄膜炎的疗效和安全性:观察性研究的荟萃分析

The Efficacy and Safety of Infliximab in Refractory Noninfectious Uveitis: A Meta-Analysis of Observational Studies.

作者信息

Xiong Anji, Liu Deng, Chen Huini, Yang Guancui, Xiong Chen, Shuai Yu, He Linqian, Guo Zepeng, Zhang Liangwen, Yang Yuan, Cui Beibei, Shuai Shiquan

机构信息

Department of Rheumatology and Immunology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China.

Inflammation and Immunology Key Laboratory of Nanchong, Nanchong, China.

出版信息

Front Pharmacol. 2021 Sep 16;12:620340. doi: 10.3389/fphar.2021.620340. eCollection 2021.

Abstract

Although infliximab has been recommended for the second-line treatment of seronegative spondyloarthropathy- or juvenile idiopathic arthritis-related uveitis, the issue of its systemic efficacy and safety in a broader diversity of refractory noninfectious uveitis is debatable. To assess the short-term and relatively long-term efficacy of infliximab in refractory noninfectious uveitis, we performed a systematic review and meta-analysis of observational studies. PubMed, Cochrane Library, EMBASE, and Wanfang Med Online were systematically searched from January 2005 to March 2020. Two investigators independently assessed eligibility. Data were independently collected by two investigators. The pooled proportions were estimated with patients for intraocular inflammation control and improvement of visual acuity. Pooled proportions with 95% credible intervals were computed. Study homogeneity was investigated using statistics to quantify the percentage of variation across studies. To pool the results, the Mantel-Haenszel fixed-effects or random-effects models were used. Of 2316 studies identified, 16 unique studies with 509 unique participants were included in the meta-analysis. The pooled proportions of intraocular inflammation control reached 92% (95% CI: 87%-98%; : 1%; p=0.42) and 95% (95% CI: 93%-97%; : 0%; p=0.91) in groups of ≤6- and ≥12-month follow-up durations. During the relatively long follow-up period, the pooled proportions of maintaining visual acuity stable or increasing at least one line reached 99% (95% CI: 96%-100%; : 0%; p=0.54) in the involved eyes. The corticosteroid-sparing effect of infliximab was also well demonstrated, with the proportion of corticosteroid-sparing success reaching 85.5% (112/131). Besides, about serious adverse events, 2.6% (13/500) of patients experienced hypersensitivity reactions, 2.4% (12/500) of patients experienced serious infections, 1.8% (9/500) of patients experienced autoimmune diseases, and 0.6% (3/500) of patients experienced neoplasia. This meta-analysis provided evidence that infliximab might be a promising choice in controlling inflammatory activity, gaining visual acuity, and sparing corticosteroid use with relatively few side effects when applied in treating refractory noninfectious uveitis. : [website], identifier [registration number].

摘要

尽管英夫利昔单抗已被推荐用于血清阴性脊柱关节病或青少年特发性关节炎相关葡萄膜炎的二线治疗,但在更广泛的难治性非感染性葡萄膜炎中,其全身疗效和安全性问题仍存在争议。为了评估英夫利昔单抗在难治性非感染性葡萄膜炎中的短期和相对长期疗效,我们对观察性研究进行了系统评价和荟萃分析。从2005年1月至2020年3月,我们系统检索了PubMed、Cochrane图书馆、EMBASE和万方医学在线。两名研究者独立评估研究的纳入资格。数据由两名研究者独立收集。采用患者的合并比例来评估眼内炎症控制情况和视力改善情况。计算合并比例及其95%可信区间。使用统计方法调查研究同质性,以量化各研究间变异的百分比。为汇总结果,采用Mantel-Haenszel固定效应模型或随机效应模型。在检索到的2316项研究中,有16项独特的研究、509名独特的参与者被纳入荟萃分析。在随访时间≤6个月和≥12个月的组中,眼内炎症控制的合并比例分别达到92%(95%CI:87%-98%;I²:1%;p=0.42)和95%(95%CI:93%-97%;I²:0%;p=0.91)。在相对较长的随访期内,患眼中视力保持稳定或至少提高一行的合并比例达到99%(95%CI:96%-100%;I²:0%;p=0.54)。英夫利昔单抗的激素节省效果也得到了充分证明,激素节省成功的比例达到85.5%(112/131)。此外,关于严重不良事件,2.6%(13/500)的患者发生过敏反应,2.4%(12/500)的患者发生严重感染,1.8%(9/500)的患者发生自身免疫性疾病,0.6%(3/500)的患者发生肿瘤。这项荟萃分析提供了证据,表明英夫利昔单抗在治疗难治性非感染性葡萄膜炎时,在控制炎症活动、提高视力和减少激素使用方面可能是一个有前景的选择,且副作用相对较少。:[网站],标识符[注册号]

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c05/8481770/e6b169a892a3/fphar-12-620340-g001.jpg

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