阿达木单抗和糖皮质激素减量治疗Vogt-小柳原田综合征的疗效  

Efficacy of Adalimumab with dose-reduced glucocorticoid for the treatment of Vogt-Koyanagi-Harada disease

作　　者：桂衍超 段梅 管一鸣 桂思语 倪沁雨 陶黎明[1] 蒋正轩[1] Yan-Chao Gui;Mei Duan;Yi-Ming Guan;Si-Yu Gui;Qin-Yu Ni;Li-Ming Tao;Zheng-Xuan Jiang(Department of Ophthalmology,the Second Hospital of Anhui Medical University,Hefei 230601,Anhui Province,China)

机构地区：[1]安徽医科大学第二附属医院眼科,安徽合肥230601

出　　处：《国际眼科杂志》2022年第12期2068-2072,共5页International Eye Science

基　　金：国家自然科学基金项目(No.82070986,82171043)。

摘　　要：目的:评估阿达木单抗(ADA)及糖皮质激素减量治疗Vogt-小柳原田综合征(VKH综合征)的临床疗效。方法:纳入2020-08/2021-12在我院眼科接受ADA治疗的VKH综合征患者21例37眼,眼内炎症控制并持续3mo后逐步延长ADA给药间隔,如炎症复发则恢复为初始治疗间隔。随访12mo,比较首次注射ADA治疗前后前房细胞(ACC)等级、玻璃体混浊(VH)等级、视网膜/脉络膜炎、浆液性视网膜脱离(SRD)、最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、糖皮质激素及免疫抑制剂使用剂量,记录治疗失败事件和不良反应。结果:与基线相比,治疗后2wk,1、3、6mo,纳入患者ACC等级≤1+、VH等级≤1+的患眼比例提高(P<0.05),伴视网膜/脉络膜炎的患眼比例明显降低(P<0.01),BCVA和CMT均显著改善(P<0.01),糖皮质激素平均用量明显减少(P<0.01)。终末随访时82%的患者糖皮质激素用量≤5mg,所有患者均停止使用免疫抑制剂。随访期间发生治疗失败事件13次,延长ADA治疗间隔的患者12例(57%),未发现与ADA治疗相关的严重不良事件。结论:ADA治疗VKH综合征具有良好的疗效,能够减少糖皮质激素和免疫抑制剂的用量,延长ADA治疗间隔是有效的,且复发率较低。AIM:To evaluate the clinical efficacy of adalimumab(ADA)with dose-reduced glucocorticoid for the treatment of Vogt-Koyanagi-Harada disease(VKH).METHODS:A total of 21 patients(37 eyes)with VKH who received ADA therapy in the Department of Ophthalmology of our hospital from August 2020 to December 2021 were included.The interval of ADA administration was progressively extended after intraocular inflammation controlled and lasted for 3mo,and it returned to the initial treatment interval once the inflammation recurred.After follow-up for 12mo,anterior chamber cell(ACC)grade,vitreous haze(VH)grade,retinal/choroidal lesions,serous retinal detachment(SRD),best corrected visual acuity(BCVA),central macular thickness(CMT)and doses of glucocorticoid and immunosuppressant were compared before and after the first ADA injection.Treatment failure events and adverse reactions were recorded.RESULTS:Compared with baseline,the proportion of eyes with ACC grade≤1+and VH grade≤1+increased(P<0.05),the proportion of eyes with retinal/choroidal lesions decreased significantly(P<0.01),BCVA and CMT were significantly improved(P<0.01),and the average dose of glucocorticoid reduced significantly(P<0.01)at 2wk,1,3 and 6mo after treatment.At the final follow-up,82%of patients received glucocorticoid≤5 mg,and all patients stopped using immunosuppressant.There were 13 treatment failure events during the follow-up period,and 12 patients(57%)extended the ADA treatment interval,with no serious adverse events related to ADA treatment observed.CONCLUSION:ADA is effective and safe for the treatment of VKH,reducing the need for glucocorticoid and immunosuppressant.In addition,extending the interval of ADA treatment is effective,which has a lower recurrence rate.

关 键 词：阿达木单抗 肿瘤坏死因子-Α VOGT-小柳原田综合征 糖皮质激素 疗效 

分 类 号：R773[医药卫生—眼科]