摘 要

目 的：

评估托珠单抗在白塞病伴发难治性葡萄膜炎患者中的疗效。

方 法：

白塞病伴发葡萄膜炎患者来自多个中心。传统的免疫抑制剂及生物制剂治疗后，白塞病患者葡萄膜炎仍反复发作。通过观察下述指标来评价：眼睛局部炎症、黄斑厚度、视力和皮质类固醇等。

结 果：

研究包括11例患者(男性7例，20只眼受累)，中位年龄：35岁。双侧葡萄膜炎占9例。葡萄膜炎分型：全葡萄膜炎(8例，其中4例有视网膜血管炎)，前葡萄膜炎2例，后葡萄膜炎1例。7例患者黄斑有囊样水肿。临床病程：7例呈反复发作，4例呈慢性。在托珠单抗治疗前，患者已接受下列治疗：系统的激素、传统免疫抑制剂，生物制剂(阿达木单抗8例，英夫利昔单抗4例，戈利木单抗3例，益赛普1例)。托珠单抗单独或联合用药剂量：10例=8mg/Kg/4周，或1例=162mg/周。在托珠单抗治疗时，白塞病患者眼外表现如下： 或生殖器溃疡7例，关节炎4例，毛囊炎或假性毛囊炎4例，结节性红斑2例，网状青斑1例，2例神经系统受累。托珠单抗治疗后，所有患者的眼部上述指标均改善，完全缓解8例。但对于眼外表现，仅3例有效。平均随访9.5月，2例患者分别因严重的输液反应和关节炎停用托珠单抗。

结 论：

对于白塞病患者伴发难治性葡萄膜炎，托珠单抗可以作为一种治疗选择。

参考文献：

Rheumatology (Oxford).2018Feb 19. doi: 10.1093/rheumatology/kex480. [Epub ahead of print]

Anti-interleukin 6 receptor tocilizumab in refractory uveitis associated with Behçet'sdisease: multicentre retrospective study

Abstract

OBJECTIVE:

To assess the efficacy of tocilizumab (TCZ) in refractory uveitis of Behçet'sdisease(BD).

METHODS:

Multicentre study of patients with BD-associated uveitis. Patients were refractory to conventional and biologic immunosuppressive drugs. The main outcome measures were intraocular inflammation, macular thickness, visual acuity and corticosteroid-sparing effects.

RESULTS:

We studied 11 patients (7 men) (20 affected eyes); median age 35 years. Uveitis was bilateral in nine patients. The patterns of ocular involvement were panuveitis (n = 8, with retinal vasculitis in 4), anterior uveitis (n = 2) and posterior uveitis (n = 1). Cystoid macular oedema was present in seven patients. The clinical course was recurrent (n = 7) or chronic (n = 4). Before TCZ, patients had received systemic corticosteroids, conventional immunosuppressants and the following biologic agents: adalimumab (n = 8), infliximab (n = 4), canakimumab (n = 1), golimumab (n = 3), etanercept (n = 1). TCZ was used as monotherapy or combined with conventional immunosuppressants at 8 mg/kg/i.v./4 weeks (n = 10) or 162 mg/s.c./week (n = 1). At TCZ onset the following extraocular manifestations were present: oral and/or genital ulcers (n = 7), arthritis (n = 4), folliculitis/pseudofolliculitis (n = 4), erythema nodosum (n = 2), livedo reticularis (n = 1) and neurological involvement (n = 2). TCZ yielded rapid and maintained improvement in all ocular parameters of the patients, with complete remission in eight of them. However, this was not the case for the extraocular manifestations, since TCZ was onlyeffective in three of them. After a mean (s.d.) follow-up of 9.5 (8.05) months, TCZ was withdrawn in two cases, due to a severe infusion reaction and arthritis impairment, respectively.

CONCLUSION:

TCZ could be a therapeutic option in patients with BD and refractory uveitis.