Objective

To compare the efficacy and safety of Disease-modifying antirheumatic drugs (DMARDs) and anti-TNF-α agents in patients with non-infectious non-anterior uveitis.

Methods

Single center retrospective study including adult patients with non-infectious intermediate, posterior or pan-uveitis. Outcomes were compared between patients treated with DMARDs or anti-TNF-α agents. The primary outcome was treatment failure or occurrence of serious adverse events. Treatment failure was determined by ophthalmologic criteria.

Results

Seventy-three patients were included, mostly female (52%). Among them, 39 were treated with DMARDs and 34 with anti-TNF-α agents. The main uveitis causes were idiopathic (30%), birdshot chorio-retinopathy (25%), sarcoidosis (16%) and Behçet's disease (14%). The primary outcome was observed in 56% of patients treated with anti-TNF-α agents versus 59% of patients treated with DMARDs (p = 0.82). Median time to observe the primary outcome was 16 months (anti-TNF-α group) versus 21 months (p = 0.52). There was no significant difference between the two groups in terms of treatment failure, corticosteroid sparing effect, visual acuity improvement or adverse events. Earlier control of ocular inflammation was achieved with anti-TNF-α agents than with DMARDs (p = 0.006). In relapsing patients, anti-TNF-α agents allowed better corticosteroid sparing (p = 0.06).

Conclusion

DMARDs could still be used as first-line therapy for non-infectious non-anterior uveitis after corticosteroid therapy. However, anti-TNF-α agents could be proposed as an alternative in cases of severe inflammation or initial high level of steroid dependency.

中文翻译：

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非感染性非前葡萄膜炎中常规免疫抑制药物与抗 TNF-α 药物的比较。

客观的

比较疾病缓解性抗风湿药物 (DMARDs) 和抗 TNF-α 药物在非感染性非前葡萄膜炎患者中的疗效和安全性。

方法

单中心回顾性研究，包括患有非感染性中间葡萄膜炎、后葡萄膜炎或泛葡萄膜炎的成年患者。比较了接受 DMARD 或抗 TNF-α 药物治疗的患者的结果。主要结果是治疗失败或严重不良事件的发生。治疗失败由眼科标准确定。

结果

包括 73 名患者，主要是女性 (52%)。其中，39 人接受 DMARDs 治疗，34 人接受抗 TNF-α 药物治疗。主要的葡萄膜炎病因是特发性 (30%)、鸟类绒毛膜视网膜病变 (25%)、结节病 (16%) 和 Behçet 病 (14%)。在接受抗 TNF-α 药物治疗的患者中，56% 的患者观察到了主要结果，而接受 DMARDs 治疗的患者中，这一比例为 59%（p = 0.82）。观察主要结果的中位时间为 16 个月（抗 TNF-α 组）与 21 个月（p = 0.52）。两组在治疗失败、皮质类固醇节约效果、视力改善或不良事件方面没有显着差异。使用抗 TNF-α 药物比使用 DMARDs 更早地控制眼部炎症（p = 0.006）。在复发患者中，

结论

DMARDs 仍可用作皮质类固醇治疗后非感染性非前葡萄膜炎的一线治疗。然而，在严重炎症或初始高度依赖类固醇的情况下，可以建议使用抗 TNF-α 药物作为替代方案。