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Impact of systemic treatments on the course of HLA-B27-associated uveitis: A retrospective study of 101 patients.
PLOS ONE ( IF 3.7 ) Pub Date : 2020-03-31 , DOI: 10.1371/journal.pone.0230560
Nabil Bouzid 1 , Yvan Jamilloux 1 , Roland Chapurlat 2 , Pierre Pradat 3 , Audrey De Parisot 1 , Laurent Kodjikian 4 , Pascal Sève 1
Affiliation  

Purpose

To investigate the efficacy and tolerance of systemic treatments for the prevention of HLA-B27-associated acute uveitis (AU) recurrence.

Methods

Retrospective review of patients with HLA-B27-associated uveitis followed in our tertiary center over a 15-year period. Systemic treatments were prescribed to patients with frequent (more than 2 flares per year) or severe uveitis, according to a step-up strategy

Results

101 patients (51.5% of men, 88.1% of white Europeans) with a median age of 37 years. AU was mostly recurrent (68.3%) and associated with spondyloarthritis (60.4%). After a median follow-up duration of 22 months (3–73), 37.6% of the patients have received systemic treatment. 88.5% of the patients have been treated with sulfasalazine (SSZ) for ophthalmologic purposes (23/26). Methotrexate (MTX) and anti-TNFα agents have been initiated for a rheumatologic indication in 81.8% (9/11) and 100% of the patients (13/13), respectively. The annual uveitis relapse rate significantly decreased on SSZ (0.37 recurrences/year versus baseline 2.46 recurrences/year; p<0.001) and MTX (1.54 recurrences/year versus 4.17/year; p = 0.008). Patients under ADA for ophthalmologic purposes (n = 2) did not experience any recurrence.

Conclusion

We report an open-label strategy to prevent the recurrences of HLA-B27-associated AU. First-line sulfasalazine reduced uveitis relapses. The use of anti-TNFα agents for ophthalmologic purposes was unnecessary with rare exceptions.



中文翻译:

全身性治疗对HLA-B27相关葡萄膜炎病程的影响:一项101例患者的回顾性研究。

目的

目的探讨预防HLA-B27相关的急性葡萄膜炎(AU)复发的全身治疗的疗效和耐受性。

方法

在我们的三级中心对HLA-B27相关葡萄膜炎患者进行了15年的回顾性研究。根据逐步治疗策略,对频发(每年两次以上发作)或重度葡萄膜炎的患者开具全身治疗方案

结果

101名患者(男性为51.5%,欧洲白人为88.1%),中位年龄为37岁。AU多为复发(68.3%),并伴有脊椎关节炎(60.4%)。中位随访期为22个月(3–73)后,有37.6%的患者接受了全身治疗。88.5%的患者出于眼科目的接受柳氮磺胺吡啶(SSZ)的治疗(23/26)。甲氨蝶呤(MTX)和抗TNFα药物已开始用于风湿病适应症,分别有81.8%(9/11)和100%的患者(13/13)。SSZ的年葡萄膜炎复发率显着降低(0.33例/年,基线2.46例/年; p <0.001)和MTX(1.54例/年,4.17例/年; p = 0.008)。出于眼科目的而接受ADA的患者(n = 2)没有复发。

结论

我们报告了一种开放标签的策略,以防止HLA B27相关AU的复发。一线柳氮磺胺吡啶可减少葡萄膜炎复发。除极少数情况外,无需将抗TNFα药物用于眼科目的。

更新日期:2020-03-31
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