戈利木单抗治疗非感染性难治性葡萄膜炎的初步疗效  

Efficacy and safety of golimumab in the treatment of refractory non-infectious uveitis

作　　者：周强[1] 陶勇[1] Zhou Qiang;Tao Yong(Department of Ophthalmology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院眼科,北京100020

出　　处：《解放军医学杂志》2021年第7期673-677,共5页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金面上项目(82070948);北京市教育委员会科研计划资助项目(KM202010025020)~~。

摘　　要：目的探讨戈利木单抗(GLM)治疗非感染性难治性葡萄膜炎的初步疗效。方法回顾性分析2018年10月-2019年12月于首都医科大学附属北京朝阳医院眼科使用GLM治疗(50 mg/月,持续3个月)的46例非感染性难治性葡萄膜炎患者的临床资料,记录随访及预后情况,以及主要不良反应的发生情况。结果 46例非感染性难治性葡萄膜炎患者均对传统免疫抑制剂反应不佳。34例在GLM治疗后病情控制或缓解,总有效率为73.91%。86只受累眼治疗后视力logMAR值降低,与治疗前比较差异有统计学意义(0.22 vs.0.26,P=0.002)。9例(19.57%)停药后至随访截止时无复发,17例(36.96%)在随访截止时仍维持用药,炎症无复发。维持GLM用药的患者中,13例单用GLM维持,4例仍需联合原有的免疫抑制剂治疗。联合用药的种类[M(Q_1,Q_3)]由治疗前的2(2,3)种减少为随访末期的1(1,2)种(P<0.001);泼尼松维持用药量由治疗前的38(30,45) mg/d减量为治疗后的8(5,15) mg/d(P<0.001)。应用GLM后,发生细菌性肺炎1例,过敏反应2例,转氨酶升高1例。结论 GLM可有效减少非感染性难治性葡萄膜炎的复发次数,改善患者视力,减少激素和免疫抑制剂的联合使用种类及剂量。Objective To explore the short-term efficacy and safety of golimumab(GLM)for treatment of refractory non-infectious uveitis.Methods Nonrandomized retrospective case series.Forty-six patients in Department of Ophthalmology Beijing Chaoyang Hospital from October 2018 to December 2019 with different types of uveitis that were resistant to treatment with previous immunosuppressors were included in this study.All the patients were treated with GLM(50 mg every four weeks)during at least 3 months.Clinical evaluation and treatment-related side effects were assessed in all included patients.Results At the end of follow up,ocular inflammation was controlled or relieved in 34 patients,the response rate was 73.91%.There was a statistically significant improvement in mean best corrected visual acuity(0.22 vs.0.26,P=0.002).GLM therapy achieved complete control of inflammation in 9 patients(19.57%).GLM was continuously used in 17 patients(36.96%)without inflammation recurrence,including single GLM treatment in 14 patients,and combination with conventional immunosuppressors in 3 patients.The types of conventional immunosuppressors[M(Q1,Q3)]decreased from 2(2,3)to 1(1,2)(P<0.001)after GLM treatment.The dosage of prednisone decreased from 38 mg/d[(30,45)mg/d]at baseline to 8 mg/d[(5,15)mg/d](P<0.001).The systemic adverse effects associated with GLM therapy were observed in 4 patients,including bacterial pneumonia in 1 patient,anaphylactic reaction in 2 patients,and transaminase elevation in 1 patient.Conclusion GLM can effectively reduce the recurrence of non-infectious refractory uveitis,improve patients'vision,and reduce the combined use of glucocorticoid and immunosuppressors.

关 键 词：葡萄膜炎 戈利木单抗 生物制剂 肿瘤坏死因子拮抗剂 

分 类 号：R773[医药卫生—眼科]