PDF(Pubmed)
Abstract：
UNASSIGNED: Since adalimumab approval in childhood chronic non-infectious uveitis (cNIU), the prognosis has been dramatically changed, but the 25 % failed to achieve inactivity. There is not accordance if it is better to switch to another anti-TNF or to swap to another category of biologic. Thus, we aim to summarize evidence regarding the best treatment of cNIU refractory to the first anti-TNF.
UNASSIGNED: A systematic literature review and meta-analysis, according to PRISMA Guidelines, was performed(Jan2000-Aug2023). Studies investigating the efficacy of treatment in cNIU refractory to the first anti-TNF were considered for inclusion. The primary outcome was the improvement of intraocular inflammation according to SUN. A combined estimation of the proportion of children responding to switch or swap and for each drug was performed.
UNASSIGNED: 23 articles were eligible, reporting 150 children of whom 109 switched anti-TNF (45 adalimumab, 49 infliximab, 9 golimumab) and 41 swapped to another biologics (31 abatacept, 8 tocilizumab and 1 rituximab). The proportion of responding children was 46 %(95 % CI 23-70) for switch and 38 %(95 % CI 8-73) for swap (χ20.02, p = 0.86). Instead analysing for each drug, the proportion of responding children was the 24 %(95 % CI 2-55) for adalimumab, 43 %(95 % CI 2-80) for abatacept, 79 %(95 % CI 61-93) for infliximab, 56 %(95 % CI 14-95) for golimumab and 96 %(95 % CI 58-100) for tocilizumab. We evaluated a superiority of tocilizumab and infliximab compared to the other drugs(χ2 27.5 p < 0.0001).
UNASSIGNED: Although non-conclusive, this meta-analysis suggests that, after the first anti-TNF failure, tocilizumab and infliximab are the best available treatment for the management of cNIU.
UNASSIGNED: A systematic literature review and meta-analysis, according to PRISMA Guidelines, was performed(Jan2000-Aug2023). Studies investigating the efficacy of treatment in cNIU refractory to the first anti-TNF were considered for inclusion. The primary outcome was the improvement of intraocular inflammation according to SUN. A combined estimation of the proportion of children responding to switch or swap and for each drug was performed.
UNASSIGNED: 23 articles were eligible, reporting 150 children of whom 109 switched anti-TNF (45 adalimumab, 49 infliximab, 9 golimumab) and 41 swapped to another biologics (31 abatacept, 8 tocilizumab and 1 rituximab). The proportion of responding children was 46 %(95 % CI 23-70) for switch and 38 %(95 % CI 8-73) for swap (χ20.02, p = 0.86). Instead analysing for each drug, the proportion of responding children was the 24 %(95 % CI 2-55) for adalimumab, 43 %(95 % CI 2-80) for abatacept, 79 %(95 % CI 61-93) for infliximab, 56 %(95 % CI 14-95) for golimumab and 96 %(95 % CI 58-100) for tocilizumab. We evaluated a superiority of tocilizumab and infliximab compared to the other drugs(χ2 27.5 p < 0.0001).
UNASSIGNED: Although non-conclusive, this meta-analysis suggests that, after the first anti-TNF failure, tocilizumab and infliximab are the best available treatment for the management of cNIU.
摘要：
■自从阿达木单抗在儿童慢性非感染性葡萄膜炎（cNIU）中获得批准以来，预后发生了巨大变化，但是25%的人没有达到不活动。如果更好地切换到另一种抗TNF或交换到另一种生物制剂，则不一致。因此，我们的目的是总结有关cNIU对首次抗TNF难治性的最佳治疗的证据。
■系统的文献综述和荟萃分析，根据PRISMA指南，进行了(Jan2000-Aug2023)。研究对第一抗TNF难治性cNIU的治疗功效的研究被认为包括在内。主要结果是根据SUN改善眼内炎症。对每种药物对转换或交换做出反应的儿童比例进行了综合评估。
■有23篇文章符合条件，报告150名儿童，其中109名改用抗TNF（45名阿达木单抗，49英夫利昔单抗,9golimumab)和41个换成另一种生物制剂(31abatacept，8托珠单抗和1利妥昔单抗）。有反应的儿童比例为46％（95％CI23-70），交换为38％（95％CI8-73）（χ20.02，p=0.86）。而是分析每种药物，应答儿童的比例为阿达木单抗的24%（95%CI2-55），43％（95％CI2-80）用于阿巴蒂普，英夫利昔单抗的79%（95%CI61-93），戈利木单抗为56%（95%CI14-95），托珠单抗为96%（95%CI58-100）。我们评估了托珠单抗和英夫利昔单抗与其他药物相比的优越性（χ227.5p<0.0001）。
■虽然没有定论，这项荟萃分析表明，在第一次抗TNF失败后，托珠单抗和英夫利昔单抗是cNIU的最佳治疗方法.
■系统的文献综述和荟萃分析，根据PRISMA指南，进行了(Jan2000-Aug2023)。研究对第一抗TNF难治性cNIU的治疗功效的研究被认为包括在内。主要结果是根据SUN改善眼内炎症。对每种药物对转换或交换做出反应的儿童比例进行了综合评估。
■有23篇文章符合条件，报告150名儿童，其中109名改用抗TNF（45名阿达木单抗，49英夫利昔单抗,9golimumab)和41个换成另一种生物制剂(31abatacept，8托珠单抗和1利妥昔单抗）。有反应的儿童比例为46％（95％CI23-70），交换为38％（95％CI8-73）（χ20.02，p=0.86）。而是分析每种药物，应答儿童的比例为阿达木单抗的24%（95%CI2-55），43％（95％CI2-80）用于阿巴蒂普，英夫利昔单抗的79%（95%CI61-93），戈利木单抗为56%（95%CI14-95），托珠单抗为96%（95%CI58-100）。我们评估了托珠单抗和英夫利昔单抗与其他药物相比的优越性（χ227.5p<0.0001）。
■虽然没有定论，这项荟萃分析表明，在第一次抗TNF失败后，托珠单抗和英夫利昔单抗是cNIU的最佳治疗方法.
