英夫利西单抗治疗难治性白塞病葡萄膜炎的疗效及安全性

Efficacy and safety of infliximab treatment for refractory Behcet's uveitis

目的探讨英夫利西单抗(infliximab,IFX)治疗难治性白塞病葡萄膜炎(Behcet's disease uveitis,BDU)的疗效与安全性。方法对2014年7月至2018年7月北京协和医院风湿免疫科和眼科门诊收治的8例难治性复发性BDU患者给予IFX治疗。在糖皮质激素和/或免疫抑制剂治疗基础上,IFX剂量为5 mg/kg。主要观察指标是BDU患者视力改善及复发减少;次要观察指标是激素和免疫抑制剂的节约效应,以及IFX不良反应。结果8例患者均男性,BD发病年龄平均(27.8±7.9)岁,均为难治性复发性全葡萄膜炎伴视网膜血管炎,4例(50%)出现黄斑水肿。经过IFX治疗,BDU复发中位次数由治疗前2.5(范围1~4)次/6个月减少至用药第6个月的1(范围0~1)次/6个月(P=0.003),第12个月时继续减少为0次/6个月(与基线相比P<0.0001,与第6个月相比P=0.008)。受累眼视力由治疗前的0.15(范围0.01~0.60)提高到IFX治疗后0.50(范围0.06~0.10)(P<0.0001)。口服激素剂量由IFX治疗前的中位数26.25(范围20~35)mg/d,减量为第6个月时的15(范围10~20)mg/d(P<0.0001),第12个月时10(范围0~15)mg/d(与基线相比P<0.0001,与第6个月相比P=0.035);同时联合应用的免疫抑制剂种类由3(范围1~4)种减少为1(范围0~1)种(P=0.001)。应用IFX后,2例(25%)出现轻度感染,抗感染治疗后好转。结论在糖皮质激素和免疫抑制剂治疗的基础上,IFX可以有效减少难治性BDU复发次数,改善患者视力,不良反应少,且具有一定的激素和免疫抑制剂节约效应。

Objective To investigate the efficacy and safety of infliximab(IFX)treatment on Behcet's refractory uveitis(BDU).Methods Eight refractory BDU patients who received IFX(5 mg/kg)on the basis of corticosteroid and immunosuppressants in Peking Union Medical College Hospital between July 2014 and July 2018 were retrospectively reviewed.The primary outcomes were visual acuity and uveitis relapses.The secondary outcomes were corticosteroid-and immunosuppressant-sparing effects and side effects of IFX.Results Eight males with a mean age of(27.8±7.9)years were included.All 8 patients were sight-threatening panuveitis with retinal vasculitis,and macular edema was presented in 4(50%).After IFX initiation,frequencies of relapse reduced from 2.5(range 1-4)/6 months at baseline to 1(range 0-1)/6 months,and 0/6 months at the 6th and the 12th month,respectively(baseline vs.6th month,P=0.003;baseline vs.12th month,P<0.0001).Significant improvement of visual acuity(from 0.15(range 0.01-0.60)to 0.50(range 0.06-0.10),P<0.0001)was also noted in this study.In addition,dosage of corticosteroid decreased from 26.25(range 20-35)mg/d at baseline to 15(range 10-20)mg/d and 10(range 0-15)mg/d at the 6th month and the 12th month of the follow-up,respectively(baseline vs.6th month,P<0.0001;baseline vs.12th month,P<0.0001).The types of conventional immunosuppressants decreased from 3(range 1-4)to 1(range 0-1)(P=0.001)as well after IFX treatment.No severe adverse events were observed.Conclusion IFX is effective and safe in treatment of refractory BDU,with significant steroid-and immnunosuppressant-sparing effects.