Department of Epidemiology, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Ophthalmology, the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
Retina. 2023 Sep 1;43(9):1480-1486. doi: 10.1097/IAE.0000000000003836.
To evaluate the effectiveness of tacrolimus in patients with noninfectious intermediate, posterior, or panuveitis needing a two-immunosuppressive-agent regimen.
Design: Retrospective cohort study. Setting: Two tertiary-care uveitis practices at academic medical centers. Patient population: Thirty-two patients with noninfectious intermediate, posterior, or panuveitides in whom single-agent immunosuppression was inadequate to effect successful corticosteroid sparing. Intervention: tacrolimus, added as the second immunosuppressive agent. Main outcome measure: successful corticosteroid sparing, defined as inactive uveitis at a dose of prednisone ≤7.5 mg/day.
Active uveitis was present in 65.6% of patients at initiation of tacrolimus, and the median time to inactive uveitis was 1.5 months (95% confidence interval 1.2, 4.08). The median time to successful corticosteroid sparing was 3.9 months (95% confidence interval 1.41, 6.67), and by 6 months of follow-up successful corticosteroid sparing was achieved in 75% of patients. Tacrolimus was discontinued for side effects in five patients, three for tremor, and two for hyperglycemia. All side effects were reversible with tacrolimus discontinuation.
Tacrolimus seems to have efficacy as a second immunosuppressive agent in two-immunosuppressive drug regimens, when a single agent does not permit successful corticosteroid sparing. Side effects were reversible with tacrolimus discontinuation.
评估他克莫司在需要两种免疫抑制剂方案的非感染性中间、后部或全葡萄膜炎患者中的疗效。
设计：回顾性队列研究。设置：两个学术医学中心的三级保健葡萄膜炎诊所。患者人群：32 例非感染性中间、后部或全葡萄膜炎患者，单一免疫抑制剂不足以成功地节省皮质类固醇。干预措施：他克莫司，作为第二种免疫抑制剂添加。主要观察指标：成功的皮质类固醇节省，定义为泼尼松剂量≤7.5mg/天的静止性葡萄膜炎。
在开始使用他克莫司时，65.6%的患者存在活动性葡萄膜炎，达到静止性葡萄膜炎的中位时间为 1.5 个月（95%置信区间 1.2，4.08）。成功的皮质类固醇节省的中位时间为 3.9 个月（95%置信区间 1.41，6.67），在 6 个月的随访中，75%的患者成功地节省了皮质类固醇。由于副作用，有 5 例患者停用了他克莫司，3 例因震颤，2 例因高血糖。所有副作用在停用他克莫司后均可逆转。
当单一药物不能成功地节省皮质类固醇时，他克莫司似乎作为两种免疫抑制剂方案中的第二种免疫抑制剂具有疗效。副作用在停用他克莫司后是可逆的。
