Djian Cassandre, Champion Karine, Lai Nicolas, Drouet Ludovic, Amador Borrero Blanca, Depond Audrey, Mouly Stéphane, Jourdaine Clément, Herman Philippe, Eliezer Michael, Hautefort Charlotte, Sène Damien
Department of Otolaryngology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France.
Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France.
J Clin Med. 2023 Jun 28;12(13):4350. doi: 10.3390/jcm12134350.
Inflammatory labyrinthitis is defined as a fluctuant vestibulo-cochlear syndrome associated with an impairment of the blood-labyrinthine barrier (BLB) on delayed FLAIR MRI sequences. Systemic and intratympanic corticosteroids are the gold standard treatment but their effect is frequently insufficient. The objective is here to determine whether infliximab could be of value in the treatment of bilateral inflammatory labyrinthitis. A retrospective monocentric study was conducted between January 2013 and December 2021. All patients included in the study were affected with a bilateral vestibulo-cochlear syndrome associated with bilateral blood-labyrinthine barrier impairment. Patients were administered infliximab at the dose of 5 mg/kg every 6 weeks for 6 months. Audiometry, MRI with delayed FLAIR sequences on the labyrinth, and corticosteroid doses still required were assessed both before and after treatment with infliximab was completed. Pure-tone average (PTA) was the primary outcome. The secondary outcomes were the speech recognition threshold (SRT), the Dizziness Handicap Inventory (DHI) score, and the corticosteroid (CS) dose. A total of nine patients including five men and four women were enrolled in the study. Thirteen ears were analyzed. After a 6-month period of treatment, the mean PTA (54 ± 24 db versus 66 ± 22 db; = 0.027), SRT (54 ± 37 db versus 66 ± 32 db; = 0.041) and DHI score (27 ± 15 versus 9 ± 2; = 0.032) significantly improved. After the 6-month treatment period, the mean CS dose decreased from 38 ± 33 to 6 ± 5 mg/day ( = 0.003). We conclude that infliximab substantially improves the vestibulo-cochlear function in patients with bilateral inflammatory labyrinthitis and could be of value in corticosteroid-dependent cases.
炎性迷路炎被定义为一种波动性的前庭蜗综合征，在延迟液体衰减反转恢复（FLAIR）磁共振成像（MRI）序列上与血迷路屏障（BLB）受损相关。全身和鼓室内注射皮质类固醇是金标准治疗方法，但其效果往往不足。本文的目的是确定英夫利昔单抗在双侧炎性迷路炎治疗中是否具有价值。在2013年1月至2021年12月期间进行了一项回顾性单中心研究。纳入研究的所有患者均患有与双侧血迷路屏障受损相关的双侧前庭蜗综合征。患者每6周接受一次剂量为5 mg/kg的英夫利昔单抗治疗，共治疗6个月。在英夫利昔单抗治疗完成前后，评估听力测定、带有迷路延迟FLAIR序列的MRI以及仍需使用的皮质类固醇剂量。纯音平均听阈（PTA）是主要结局指标。次要结局指标为言语识别阈（SRT）、头晕残障量表（DHI）评分和皮质类固醇（CS）剂量。共有9名患者（包括5名男性和4名女性）纳入研究。分析了13只耳朵。经过6个月的治疗，平均PTA（54±24 dB对66±22 dB；P = 0.027）、SRT（54±37 dB对66±32 dB；P = 0.041）和DHI评分（27±15对9±2；P = 0.032）均有显著改善。在6个月的治疗期后，平均CS剂量从38±33降至6±5 mg/天（P = 0.003）。我们得出结论，英夫利昔单抗可显著改善双侧炎性迷路炎患者的前庭蜗功能，在依赖皮质类固醇的病例中可能具有价值。
