Kawali Ankush, Rizvi Sara, Mishra Sai Bhakti, Mahendradas Padmamalini, Shetty Rohit
Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India.
Department of Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India.
Indian J Ophthalmol. 2025 Jun 1;73(6):837-842. doi: 10.4103/IJO.IJO_2964_24. Epub 2025 May 28.
This retrospective study aimed to evaluate the effectiveness of various immunomodulatory therapy (IMT) regimens in managing non-infectious uveitis (NIU) and to identify optimal treatment strategies for refractory cases. The study focused on patients who failed primary IMT and required revisions due to uncontrolled inflammation or frequent relapses.
The study was conducted over 1 year (December 2023 to November 2024) and included patients diagnosed with NIU, scleritis, or episcleritis who failed primary IMT. The primary IMT and subsequent revisions were analyzed to identify patterns in the use of different IMT regimens and their effectiveness.
The study cohort consisted of 54 patients. Panuveitis was found to be the most common anatomical diagnosis (44.4%). The primary IMT used was predominantly methotrexate (MTx) (83.3%). The first revision of IMT often involved combination therapy, with MTx + mycophenolate mofetil (MMF) being the most common combination (24.1%). Subsequent revisions also favored combination therapy, with increasing use of biologics like Adalimumab (ADA) and tofacitinib (Tofa). Subgroup analysis revealed Vogt-Koyanagi-Harada (VKH), being the most common etiologically diagnosed uveitic entity with primary IMT failure and increased use of Tofa in subsequent revisions of IMT.
The study highlights the challenges in managing refractory uveitis. Combination therapy, particularly with MMF and MTx, is commonly advocated. The use of biologics like Tofa, especially in VKH, can be a valuable treatment option. Future prospective studies with larger cohorts are needed to validate these findings and explore the disease-specific effectiveness of IMT regimens.
本回顾性研究旨在评估各种免疫调节治疗（IMT）方案在治疗非感染性葡萄膜炎（NIU）中的有效性，并确定难治性病例的最佳治疗策略。该研究聚焦于原发性IMT失败且因炎症控制不佳或频繁复发而需要调整治疗方案的患者。
该研究历时1年（2023年12月至2024年11月），纳入了被诊断为NIU、巩膜炎或表层巩膜炎且原发性IMT失败的患者。对原发性IMT及后续调整方案进行分析，以确定不同IMT方案的使用模式及其有效性。
研究队列包括54例患者。全葡萄膜炎是最常见的解剖学诊断（44.4%）。使用的原发性IMT主要是甲氨蝶呤（MTx）（83.3%）。IMT的首次调整通常涉及联合治疗，MTx+霉酚酸酯（MMF）是最常见的联合方案（24.1%）。后续调整也倾向于联合治疗，越来越多地使用阿达木单抗（ADA）和托法替布（Tofa）等生物制剂。亚组分析显示，伏格特-小柳-原田病（VKH）是原发性IMT失败中最常见的病因诊断明确的葡萄膜炎实体，且在IMT后续调整中Tofa的使用增加。
该研究突出了难治性葡萄膜炎治疗中的挑战。联合治疗，尤其是MMF和MTx联合，是普遍提倡的。使用Tofa等生物制剂，尤其是在VKH中，可能是一种有价值的治疗选择。需要未来进行更大样本量的前瞻性研究来验证这些发现，并探索IMT方案针对特定疾病的有效性。
