Tang Lee Say Timothy Lee, Yang Verlyn, Fingret Jacob M, Zagora Sophia, Symes Richard, Younan Christine, Cornish Elisa Eleanor, Verma Nitin, Sammel Anthony, Wakefield Denis, Speden Deborah, McCluskey Peter J
Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.
Cardinal Santos Medical Center, San Juan, Manila, Philippines.
BMJ Open Ophthalmol. 2021 Sep 27;6(1):e000819. doi: 10.1136/bmjophth-2021-000819. eCollection 2021.
Biologics are rapidly emerging as an effective vision saving addition to systemic uveitis therapy. The aim of this multicentre retrospective study is to review the outcomes of a large group of patients treated with adalimumab.
A retrospective chart review of patients with refractory non-infectious, active uveitis treated with adalimumab was conducted. The main outcome measures were ability to reduce prednisolone dose, ability to control uveitis, final visual acuity and time to treatment failure.
Forty-six patients with uveitis, treated with adalimumab were included in the study. The most common anatomical uveitis phenotype was panuveitis (n=17, 37.0%). The most common diagnosis was idiopathic uveitis (n=19, 41.3%). At their latest review (mean: 4.46 years; median 4.40 years), 35 (76.1%) patients were able to discontinue corticosteroids, 11 (23.9%) patients were able to taper to <7.5 mg/day and only 1 (2.2%) patient required 10 mg of prednisone. The mean visual acuity at the latest follow-up of the worse eye was logarithm of the minimum angle of resolution (logMAR) 0.42 (SD 0.72), while the mean visual acuity of the better eye was logMAR 0.19 (SD 0.34). Of the 89 eyes, 21 (23.6%) eyes improved by at least 2 lines, 5 eyes (5.6%) deteriorated by ≥2 lines while vision was unchanged in the remaining 63 (70.8%) eyes. The time to recurrence was 1 in 12.47 person-years for adalimumab, with a 17.4% (8 patient) relapse rate. There were no serious adverse events.
This study highlights the efficacy of adalimumab in patients with vision-threatening non-infectious uveitis, preserving vision and allowing reduction of corticosteroid dose.
生物制剂正迅速成为系统性葡萄膜炎治疗中一种有效的视力挽救补充疗法。这项多中心回顾性研究的目的是回顾一大组接受阿达木单抗治疗的患者的治疗结果。
对接受阿达木单抗治疗的难治性非感染性活动性葡萄膜炎患者进行回顾性病历审查。主要结局指标为降低泼尼松龙剂量的能力、控制葡萄膜炎的能力、最终视力和治疗失败时间。
46例接受阿达木单抗治疗的葡萄膜炎患者纳入研究。最常见的解剖学葡萄膜炎表型是全葡萄膜炎（n = 1例，37.0%）。最常见的诊断是特发性葡萄膜炎（n = 19例，41.3%）。在最近一次复查时（平均：4.46年；中位数4.40年），35例（76.1%）患者能够停用皮质类固醇，11例（23.9%）患者能够减至<7.5毫克/天，只有1例（2.2%）患者需要10毫克泼尼松。在最近一次随访时，较差眼的平均视力为最小分辨角对数（logMAR）0.42（标准差0.72），而较好眼的平均视力为logMAR 0.19（标准差0.34）。在89只眼中，21只眼（23.6%）视力至少提高了2行，5只眼（5.6%）视力下降≥2行，其余63只眼（70.8%）视力无变化。阿达木单抗的复发时间为每12.47人年1次，复发率为17.4%（8例患者）。未发生严重不良事件。
本研究强调了阿达木单抗在威胁视力的非感染性葡萄膜炎患者中的疗效，可保护视力并减少皮质类固醇剂量。
