皮下注射长效促肾上腺皮质激素治疗难治性眼部炎性疾病的疗效及耐受性
Efficacy and tolerability of subcutaneous repository corticotropin injection in refractory ocular inflammatory diseases.
作者信息
Yavari Negin, Ghoraba Hashem, Or Christopher, Thng Zheng Xian, Mohammadi S Saeed, Karaca Irmak, Mobasserian Azadeh, Akhavanrezayat Amir, Le Anthony, Lyu Xun, Khatri Anadi, Yoo Woong Sun, Feky Dalia El, Than Ngoc Trong Tuong, Elaraby Osama, Saengsirinavin Aim-On, Zhang Xiaoyan, Anover Frances Andrea, Gupta Ankur Sudhir, Halim Muhammad Sohail, Jison Louis A, Nguyen Quan Dong
机构信息
Department of Ophthalmology, Byers Eye Institute, Stanford University, 2452 Watson Court Suite 200, 94303, Palo Alto, CA, USA.
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Nevona, Singapore.
出版信息
J Ophthalmic Inflamm Infect. 2024 Oct 24;14(1):56. doi: 10.1186/s12348-024-00428-8.
BACKGROUND
Repository corticotropin injection (RCI) has been suggested to exert immunomodulatory and anti-inflammatory effects in ocular inflammation. The index retrospective study aimed to evaluate the efficacy and tolerability of subcutaneous RCI in patients with active scleritis or uveitis.
MAIN BODY
Medical records of patients who were diagnosed with different types of active scleritis or uveitis and received RCI for more than six months at a tertiary eye center were reviewed. Patient characteristics including age, sex, comorbidities, clinical findings, treatment details, and adverse events were recorded. A total of 17 eyes of 17 patients were included. Median age was 43 years old and 53% of patients were male. Mean treatment duration was 25.4 ± 15.5 months. Indications for RCI therapy were scleritis (7 anterior and 1 posterior) (47.8%), panuveitis (17.4%), retinal vasculitis (17.4%), chronic/recurrent anterior uveitis (13%), and posterior uveitis (4.35%). RCI was initiated at a dose of 40 to 80 units 3 times weekly. Given the adequate control of inflammation, RCI was successfully discontinued in four patients (23.5%). Prior to RCI therapy, 14 (82.3%) patients were on oral prednisone at an average of 10 mg daily (range 2.5-40 mg), and two (11.7%) patients discontinued prednisone immediately before initiating RCI due to side effects. After six months of therapy, the prednisone dose was reduced in four (23.5%) patients to an average of 3 mg daily (range 1-5 mg) and was stopped in eight (53%) patients. Concomitant immunomodulatory therapies (IMTs) included mycophenolate mofetil (23.5%) and methotrexate (23.5%), and adalimumab (23.5%). Ten patients were on IMTs prior to using RCI, and during the course of treatment, IMT was stopped in two patients and reduced in one. Side effects included insomnia (23%), hypertension (11.7%), lower extremity edema (11.7%), hyperglycemia (11.7%), weight gain (11.7%), and infection (5.8%).
CONCLUSION
RCI may be considered as a potential therapy with acceptable tolerability for patients with non-infectious scleritis or uveitis.
背景
已有人提出储存型促肾上腺皮质激素注射液（RCI）在眼部炎症中发挥免疫调节和抗炎作用。这项回顾性研究旨在评估皮下注射RCI治疗活动性巩膜炎或葡萄膜炎患者的疗效和耐受性。
主体
回顾了在一家三级眼科中心被诊断为不同类型活动性巩膜炎或葡萄膜炎并接受RCI治疗超过6个月的患者的病历。记录了患者的特征，包括年龄、性别、合并症、临床表现、治疗细节和不良事件。共纳入17例患者的17只眼。中位年龄为43岁，53%的患者为男性。平均治疗持续时间为25.4±15.5个月。RCI治疗的适应证为巩膜炎（7例前部和1例后部）（47.8%）、全葡萄膜炎（17.4%）、视网膜血管炎（17.4%）、慢性/复发性前部葡萄膜炎（13%）和后部葡萄膜炎（4.35%）。RCI起始剂量为每周3次，每次40至80单位。鉴于炎症得到充分控制，4例患者（23.5%）成功停用RCI。在RCI治疗前，14例（82.3%）患者口服泼尼松，平均每日10mg（范围2.5 - 40mg），2例（11.7%）患者因副作用在开始RCI治疗前立即停用泼尼松。治疗6个月后，4例（23.5%）患者的泼尼松剂量减至平均每日3mg（范围1 - 5mg），8例（53%）患者停用。联合免疫调节治疗（IMT）包括霉酚酸酯（23.5%）、甲氨蝶呤（23.5%）和阿达木单抗（23.5%）。10例患者在使用RCI前接受IMT治疗，在治疗过程中，2例患者停用IMT，1例患者减少IMT剂量。副作用包括失眠（23%）、高血压（11.7%）、下肢水肿（11.7%）、高血糖（11.7%）、体重增加（11.7%）和感染（5.8%）。
结论
对于非感染性巩膜炎或葡萄膜炎患者，RCI可被视为一种耐受性可接受的潜在治疗方法。
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