Al Ghulaiga Faris M, Alharbi Ibrahim, Albloushi Abdulrahman F, Dheyab Abdulsalam M, Abouammoh Marwan A, Abu El-Asrar Ahmed M
Department of Ophthalmology, College of Medicine, King Saud University, P.O.Box 245, Riyadh, 11411, Saudi Arabia.
Arab National Bank Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
J Ophthalmic Inflamm Infect. 2025 Sep 26;15(1):70. doi: 10.1186/s12348-025-00522-5.
To investigate the safety and efficacy of rituximab in patients with refractory noninfectious uveitis and scleritis.
A retrospective review of 24 patients (47 eyes) treated with rituximab for refractory noninfectious uveitis and scleritis in the period between January 2018 and December 2024. The diagnosis of these patients included chronic recurrent uveitis associated with Vogt-Koyanagi-Harada disease (n = 16), idiopathic granulomatous uveitis (n = 3), multiple sclerosis-associated uveitis (n = 2), progressive subretinal fibrosis (n = 1) and scleritis (n = 2). The primary outcomes were disease quiescence and improvement in best-corrected visual acuity (BCVA). Secondary outcomes included reduction in corticosteroid and immunosuppressive therapy and adverse events.
Rituximab was successful in inducing and maintaining disease quiescence and significantly improved visual acuity in patients presenting with uveitis and scleritis. After starting rituximab therapy, BCVA improved at 1 year from 0.93 ± 0.67 logMAR (Snellen: 20/160) to 0.63 ± 0.83 logMAR (Snellen: 20/80) (p < 0.001). Follow-up period ranged from 12 to 80 months (mean 41 ± SD 20.5). At the last follow-up, BCVA continued to improve to 0.46 ± 0.73 logMAR (Snellen: 20/60) (p < 0.001). Nine of twenty-four patients (37.5%) required more than 3 rituximab doses for disease control. Rituximab successfully reduced corticosteroid use, allowing 87.5% (21/24) of patients to discontinue steroids completely, with the remaining needing ≤ 7.5 mg/day. Mycophenolate mofetil dosage significantly decreased from a mean of 1840 ± SD 323 mg to 1045 ± SD 688 mg daily (p < 0.001), with two patients discontinuing all medications. All patients were flare-free at last follow-up.
Rituximab is an effective and safe treatment for refractory noninfectious uveitis and scleritis. It offers significant visual improvement, disease quiescence which potentially reduces reliance on corticosteroids and immunomodulatory therapy.
探讨利妥昔单抗治疗难治性非感染性葡萄膜炎和巩膜炎患者的安全性和有效性。
回顾性分析2018年1月至2024年12月期间接受利妥昔单抗治疗的24例（47只眼）难治性非感染性葡萄膜炎和巩膜炎患者。这些患者的诊断包括与伏格特-小柳-原田病相关的慢性复发性葡萄膜炎（n = 16）、特发性肉芽肿性葡萄膜炎（n = 3）、多发性硬化相关葡萄膜炎（n = 2）、进行性视网膜下纤维化（n = 1）和巩膜炎（n = 2）。主要结局为疾病静止和最佳矫正视力（BCVA）改善。次要结局包括皮质类固醇和免疫抑制治疗的减少以及不良事件。
利妥昔单抗成功诱导并维持疾病静止，显著改善了葡萄膜炎和巩膜炎患者的视力。开始利妥昔单抗治疗后，1年时BCVA从0.93±0.67 logMAR（斯内伦视力表：20/160）提高到0.63±0.83 logMAR（斯内伦视力表：20/80）（p < 0.001）。随访期为12至80个月（平均41±标准差20.5）。在最后一次随访时，BCVA继续提高到0.46±0.73 logMAR（斯内伦视力表：20/60）（p < 0.001）。24例患者中有9例（37.5%）需要超过3剂利妥昔单抗来控制疾病。利妥昔单抗成功减少了皮质类固醇的使用，使87.5%（21/24）的患者完全停用类固醇，其余患者需要≤7.5 mg/天。霉酚酸酯剂量从平均每日1840±标准差323 mg显著降至1045±标准差688 mg（p < 0.001），有2例患者停用了所有药物。所有患者在最后一次随访时均无病情复发。
利妥昔单抗是治疗难治性非感染性葡萄膜炎和巩膜炎的有效且安全的疗法。它能显著改善视力、使疾病静止，可能减少对皮质类固醇和免疫调节治疗的依赖。
