甲氨蝶呤与传统改善病情抗风湿药治疗非前部结节病相关性葡萄膜炎的对比研究
Methotrexate versus conventional disease-modifying antirheumatic drugs in the treatment of non-anterior sarcoidosis-associated uveitis.
作者信息
Leclercq Mathilde, Sève Pascal, Biard Lucie, Vautier Mathieu, Maalouf Georgina, Leroux Gaëlle, Domont Fanny, Toutée Adélaïde, Fardeau Christine, Sales de Gauzy Thomas, Touhami Sara, Kodjikian Laurent, Cacoub Patrice, Bodaghi Bahram, Saadoun David, Desbois Anne-Claire
机构信息
Department of Internal Medicine, CHU Rouen, F-76000 Rouen, France
Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire and INSERM, UMR S 959, Immunology- Immunopathology-Immunotherapy, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
出版信息
Br J Ophthalmol. 2024 Dec 17;109(1):34-40. doi: 10.1136/bjo-2024-325163.
AIMS
To compare the safety and efficacy of methotrexate (MTX), mycophenolate mofetil (MMF) and azathioprine (AZA) in non-anterior sarcoidosis-associated uveitis.
METHODS
Retrospective study including non-anterior sarcoidosis-associated uveitis according to the revised International Workshop on Ocular Sarcoidosis criteria. The primary outcome was defined as the median time to relapse or occurrence of serious adverse events leading to treatment discontinuation.
RESULTS
58 patients with non-anterior sarcoidosis-associated uveitis (MTX (n=33), MMF (n=16) and AZA (n=9)) were included. The time to treatment failure (ie, primary outcome) after adjustment for corticosteroids dose and the presence of vasculitis was significantly higher with MTX (median time of 34.5 months with MTX (IQR: 11.8 -not reached) vs 8.4 months (3.1-22.9) with MMF and 16.8 months (8.0-90.1) with AZA (p=0.020)). The risk of relapse at 12 months was more than twice lower in MTX as compared with MMF (p=0.046). Low visual acuity at the last visit was significantly lower with MTX (4% vs 9% in MMF vs 57% in AZA group (p=0.008)). Regarding all 75 lines of treatment (MTX (n=39), MMF (n=24) and AZA (n=12)), MTX was more effective than MMF and AZA to obtain treatment response at 3 months (OR 10.85; 95% CI 1.13 to 104.6; p=0.039). Significant corticosteroid-sparing effect at 12 months (p=0.035) was only observed under MTX. Serious adverse events were observed in 6/39 (15%), 5/24 (21%) and 2/12 (17%) with MTX, MMF and AZA, respectively.
CONCLUSION
In non-anterior sarcoidosis-associated uveitis, MTX seems to be more efficient compared with AZA and MMF and with an acceptable safety profile.
目的
比较甲氨蝶呤（MTX）、霉酚酸酯（MMF）和硫唑嘌呤（AZA）治疗非前部结节病相关性葡萄膜炎的安全性和有效性。
方法
根据修订后的国际眼部结节病研讨会标准，对非前部结节病相关性葡萄膜炎进行回顾性研究。主要结局定义为复发或出现导致治疗中断的严重不良事件的中位时间。
结果
纳入58例非前部结节病相关性葡萄膜炎患者（MTX组33例、MMF组16例、AZA组9例）。在调整皮质类固醇剂量和血管炎存在情况后，MTX治疗失败时间（即主要结局）显著更长（MTX组中位时间为34.5个月（四分位间距：11.8 -未达到），MMF组为8.4个月（3.1 - 22.9），AZA组为16.8个月（8.0 - 90.1），p = 0.020）。与MMF相比，MTX组12个月时的复发风险降低超过两倍（p = 0.046）。MTX组末次随访时低视力发生率显著低于MMF组（4% vs 9%）和AZA组（57%）（p = 0.008）。在所有75条治疗线（MTX组39条、MMF组24条、AZA组12条）中，MTX在3个月时获得治疗反应的效果优于MMF和AZA（比值比10.85；95%置信区间1.13至104.6；p = 0.039）。仅在MTX治疗下观察到12个月时有显著的皮质类固醇节省效应（p = 0.035）。MTX组、MMF组和AZA组分别有6/39（15%）、5/24（21%）和2/12（17%）发生严重不良事件。
结论
在非前部结节病相关性葡萄膜炎中，MTX似乎比AZA和MMF更有效，且安全性可接受。
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