■评估全身性肿瘤坏死因子-α抑制剂(TNFi)治疗非感染性葡萄膜炎(NIU)的疗效。
■这项瑞士多中心回顾性队列研究包括2001年至2018年期间需要TNFi的NIU患者。使用Cox回归分析和风险比(HR)确定新并发症发生的危险因素。
■71例患者(126只眼;平均年龄40.6±14.4岁,葡萄膜炎的平均持续时间为46.0±61.8个月),在添加TNFi后随访40.2±17.3个月。在TNFi下,视力从0.2±0.3提高到0.1±0.3logMAR(p<0.001)。接受全身性皮质类固醇治疗的患者比例从81.7%降至25.4%(p<0.001),而常规合成抗风湿药从63.4%下降到50.7%(p>0.05)。在80.2%的眼睛中,基线时出现视网膜上皮胶质增生并发症(39.7%),白内障(41.3%)和黄斑水肿(ME;27.8%)是最常见的。49.2%的眼睛在TNFi下遇到新的并发症,还包括复发(5只眼)或新发作的ME(14只眼)。需要转换TNFi与进一步的并发症相关(HR3.78,p=0.012)。
■尽管TNFi在现实生活中的疗效和耐受性是有利的,治疗通常开始较晚,即,在许多眼睛已经出现并发症之后。即使有了TNFi,新的并发症,尤其是我,不能完全避免。需要进一步的研究来评估早期开始TNFi治疗的影响。
UNASSIGNED: To evaluate the efficacy of systemic tumor necrosis factor-alpha inhibitors (TNFi) in the treatment of non-infectious uveitis (NIU).
UNASSIGNED: This Swiss multicenter retrospective cohort study included patients with NIU requiring TNFi during the period from 2001 to 2018. Risk factors for the occurrence of new complications were identified using Cox regression analysis and hazard ratios (HR).
UNASSIGNED: Seventy-one patients (126 eyes; mean age 40.6 ± 14.4 years, mean duration of uveitis 46.0 ± 61.8 months) were followed for 40.2 ± 17.3 months after addition of TNFi. Under TNFi, visual acuity improved from 0.2 ± 0.3 to 0.1 ± 0.3 logMAR (p < 0.001). The portion of patients under systemic corticosteroids decreased from 81.7% to 25.4% (p < 0.001), while that for conventional synthetic disease-modifying anti-rheumatic drugs insignificantly decreased from 63.4% to 50.7% (p > 0.05). In 80.2% of eyes, complications were present at baseline with epiretinal gliosis (39.7%), cataract (41.3%) and macular edema (ME; 27.8%) being the most common. New complications under TNFi were encountered in 49.2% of eyes, also including recurrence (5 eyes) or new onset of ME (14 eyes). The need for switching of TNFi was associated with further complications (HR 3.78, p = 0.012).
UNASSIGNED: Although the efficacy and tolerability of TNFi in a real-life setting are favorable, treatment is often initiated late, i.e., after many eyes have already developed complications. Even with TNFi, new complications, particularly ME, cannot be completely avoided. Further research is needed to assess the impact of earlier initiation of TNFi therapy.