Anti-TNF-α therapy in refractory uveitis associated with sarcoidosis: Multicenter study of 17 patients

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• 作者：Leyre Riancho-Zarrabeitia ; MD^a ; ¹ ; Vanesa Calvo-Rí ; o ; MD^a ; ¹ ; Ricardo Blanco ; MD ; PhD^a ; ² ; Marina Mesquida ; MD^b ; Alfredo M. Adan ; MD ; PhD^b ; José ; M. Herreras ; MD ; PhD^c ; Á ; ngel Aparicio ; MD^d ; Diana Peiteado-Lopez ; MD^e ; Miguel Cordero-Coma ; MD ; FEBOphth^f ; José ; Luis Garcí ; a Serrano ; MD ; PhD^g ; Norberto Ortego-Centeno ; MD ; PhD^g ; Olga Maí ; z ; MD^h ; Ana Blanco ; MD^h ; Juan Sá ; nchez-Bursó ; n ; MD ; PhDⁱ ; Sené ; n Gonzá ; lez-Suá ; rez ; MD^j ; Alejandro Fonollosa ; MD ; PhD^k ; Montserrat Santos-Gó ; mez ; MD^a ; Carmen Gonzá ; lez-Vela ; MD ; PhD^a ; Javier Loricera ; MD^a ; Trinitario Pina ; MD^a ; Miguel A. Gonzá ; lez-Gay ; MD ; PhD² ; ^a ; ^{miguelaggay@hotmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Sarcoidosis ; Uveitis ; Biologic therapy
• 刊名：Seminars in Arthritis and Rheumatism
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：45
• 期：3
• 页码：361-368
• 全文大小：469 K

文摘

To assess anti-TNF-α therapy response in uveitis associated with sarcoidosis refractory to conventional immunosuppressive therapy.

Methods

Open-label, multicenter, retrospective study on patients with sarcoid uveitis who underwent anti-TNF-α therapy because of inadequate response to conventional therapy including corticosteroids and at least 1 systemic synthetic immunosuppressive drug. The main outcome measurements were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness, and immunosuppression load.

Results

A total of 17 patients (8 men; 29 affected eyes; mean ± standard deviation age 38.4 ± 16.8; range: 13−76 years) were studied. The patients had bilateral hilar lymphadenopathy (58.8%), lung parenchyma involvement (47.1%), peripheral lymph nodes (41.2%), and involvement of other organs (52.9%). Angiotensin-converting enzyme was elevated in 58.8%. The most frequent ocular pattern was bilateral chronic relapsing panuveitis. The first biologic agent used was adalimumab in 10 (58.8%) and infliximab in 7 (41.2%) cases. Infliximab 5 mg/kg intravenously every 4−8 weeks and adalimumab 40 mg subcutaneously every 2 weeks were the most common administration patterns. In most cases anti-TNF-α therapy was given in combination with immunosuppressive drugs. The mean duration of follow-up was 33.9 ± 17.1 months. Significant improvement was observed following anti-TNF-α therapy. Baseline results versus results at 2 years from the onset of biologic therapy were the following: the median of cells in the ocular anterior chamber (interquartile range—IQR) 0.5 (0−2) versus 0 (0−0) (p = 0.003), vitritis 0 (0−1.25) versus 0 (0−0) (p = 0.008), macular thickness (391.1 ± 58.8 versus 247 ± 40.5 µm) (p = 0.028), and visual acuity 0.60 ± 0.33 versus 0.74 ± 0.27; p = 0.009. The median daily (interquartile range) dose of prednisone was also reduced from 10 (0−30) mg at the onset of the anti-TNF-α therapy to 0 (0−0) mg at 2 years (p = 0.02). Significant reduction was also achieved in the immunosuppressive load.

Conclusion

Anti-TNF-α therapy is effective in sarcoid uveitis patients refractory to conventional immunosuppressive therapy. Infliximab and adalimumab allowed a substantial reduction in prednisone dose despite having failed standard therapy.