阿达木单抗治疗严重白塞病葡萄膜炎有效

摘要（意大利） 目的：白塞病是一种慢性多系统炎症性疾病，会导致严重危害视力的葡萄膜炎。目前研究的目的是评估阿达木单抗治疗做为一种新的治疗方法治疗严重白塞病葡萄膜炎的有效性。

方法：临床数据是来自12位患者（22支眼睛）的回顾性分析。所有的患者除了现有的传统免疫抑制剂治疗外，同时接受阿达木单抗40mg皮下注射，每2周注射一次。其中8位患者是在英夫利昔单抗治疗失败后换用阿达木单抗的。主要指标包括眼部炎症活动度，葡萄膜炎发作的频率和激素的减量情况。次要指标是的最佳矫正视力（BCVA）的变化，对传统免疫抑制治疗的影响和阿达木单抗相关的副作用。

结果：患者的平均发病年龄是24.34岁，其中11位男性和1位女性。眼部受累的病例中83％双侧受累，63%为全葡萄膜炎。平均随访21个月后，除1例患者外，其他患者（占92%）葡萄膜炎均缓解，并且至少1只眼睛的BCVA得到改善。在阿达木单抗治疗后平均葡萄膜炎发作次数从2降到0.42（p<0 .001），并且所有接受阿达木单抗治疗的患者日激素用量均减少，其中7位患者完全停用激素。治疗期间没有相关副作用。

结论：我们的结果说明，对于严重和持续的白塞病葡萄膜炎患者，阿达木单抗是非常有效和安全的治疗选择，是一种合适的可以实现眼部炎症的长期控制的治疗。

附原文：Abstract OBJECTIVES:Beh?et's disease (BD) is a chronic multisystem inflammatory disorder associated to uveitis that may represent a serious sight-threatening condition. The purpose of the present study is to assess the effectiveness of adalimumab as new strategic therapeutic approach in patients affected by severe Beh?et's uveitis.METHODS:Clinical data from twelve selected patients (22 eyes) were retrospectively analysed. All patients received 40 mg of adalimumab subcutaneously, once every 2 weeks, in addition to traditional immunosuppressive on-going therapy and eight of them were switched to adalimumab after failure of infliximab therapy. Primary outcome measures included ocular inflammatory activity, frequency of uveitis attacks and steroid-sparing effect. Secondary outcomes were changes of best-corrected visual acuity (BCVA), impact on traditional immunosuppressive therapy and occurrence of adalimumab-related side effects.RESULTS:Mean age of patients (11 males and 1 female) at the onset of disease was 24.34 years (±8.62 SD). Ocular involvement resulted bilateral in 83% of cases and mainly consisted in panuveitis (68% of eyes). After mean follow-up of 21 months (±9.63 SD) all patients but one (92%) achieved uveitis remission with BCVA improvement at least in one eye. Average uveitis attacks decreased from 2 to 0,42 during adalimumab (p<0 .001) and daily-steroid dose was tapered in all adalimumab responders up to suspension in seven of them. no patient developed related side effects during adalimumab administration.conclusions:our results demonstrate that adalimumab is a very effective and safe option for treatment of patients with severe and resistant beh?et's uveitis, providing an appropriate and long-term control of ocular inflammation.

引自：Interlandi E1, Leccese P, Olivieri I, et al. Adalimumab for treatment of severe Beh?et's uveitis: a retrospective long-term follow-up study. Clin Exp Rheumatol. 2014 Jul 8.