Ilaria Maccora , Sara Soldovieri , Teodoro Oliverio , Salvatore de Masi , Edoardo Marrani , Ilaria Pagnini , Maria Vincenza Mastrolia , Gabriele Simonini
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引用次数: 0
Abstract
Objective
Since adalimumab approval in childhood chronic non-infectious uveitis (cNIU), the prognosis has been dramatically changed, but the 25 % failed to achieve inactivity. There is not accordance if it is better to switch to another anti-TNF or to swap to another category of biologic. Thus, we aim to summarize evidence regarding the best treatment of cNIU refractory to the first anti-TNF.
Methods
A systematic literature review and meta-analysis, according to PRISMA Guidelines, was performed(Jan2000-Aug2023). Studies investigating the efficacy of treatment in cNIU refractory to the first anti-TNF were considered for inclusion. The primary outcome was the improvement of intraocular inflammation according to SUN. A combined estimation of the proportion of children responding to switch or swap and for each drug was performed.
Results
23 articles were eligible, reporting 150 children of whom 109 switched anti-TNF (45 adalimumab, 49 infliximab, 9 golimumab) and 41 swapped to another biologics (31 abatacept, 8 tocilizumab and 1 rituximab). The proportion of responding children was 46 %(95 % CI 23-70) for switch and 38 %(95 % CI 8-73) for swap (χ20.02, p = 0.86). Instead analysing for each drug, the proportion of responding children was the 24 %(95 % CI 2-55) for adalimumab, 43 %(95 % CI 2-80) for abatacept, 79 %(95 % CI 61-93) for infliximab, 56 %(95 % CI 14-95) for golimumab and 96 %(95 % CI 58-100) for tocilizumab. We evaluated a superiority of tocilizumab and infliximab compared to the other drugs(χ2 27.5 p < 0.0001).
Conclusion
Although non-conclusive, this meta-analysis suggests that, after the first anti-TNF failure, tocilizumab and infliximab are the best available treatment for the management of cNIU.
目的自从阿达木单抗被批准用于儿童慢性非感染性葡萄膜炎(cNIU)以来,预后发生了巨大变化,但仍有25%的患者未能达到无效状态。目前尚不清楚是改用另一种抗肿瘤坏死因子(anti-TNF)更好,还是改用另一类生物制剂更好。因此,我们旨在总结有关对第一种抗肿瘤坏死因子(anti-TNF)治疗无效的 cNIU 的最佳治疗方法的证据。纳入考虑的研究对象是对首次抗肿瘤坏死因子治疗无效的 cNIU 进行疗效调查的研究。主要结果是眼内炎症的改善程度(根据 SUN 标准)。结果23篇文章符合条件,共报告了150名患儿,其中109名患儿换用了抗肿瘤坏死因子(45名阿达木单抗、49名英夫利昔单抗、9名戈利木单抗),41名患儿换用了其他生物制剂(31名阿帕他赛、8名托珠单抗和1名利妥昔单抗)。换药儿童的应答比例为 46%(95 % CI 23-70),换药儿童的应答比例为 38%(95 % CI 8-73)(χ20.02,P = 0.86)。如果对每种药物进行分析,阿达木单抗的应答儿童比例为 24%(95 % CI 2-55),阿帕他赛的应答儿童比例为 43%(95 % CI 2-80),英夫利西单抗的应答儿童比例为 79%(95 % CI 61-93),戈利木单抗的应答儿童比例为 56%(95 % CI 14-95),托珠单抗的应答儿童比例为 96%(95 % CI 58-100)。我们评估了托西珠单抗和英夫利昔单抗与其他药物相比的优越性(χ2 27.5 p < 0.0001)。结论尽管尚无定论,但这项荟萃分析表明,在首次抗肿瘤坏死因子治疗失败后,托西珠单抗和英夫利昔单抗是治疗 cNIU 的最佳药物。