| PurposeA retrospective analysis of 30 patients with refractory uveitis in our hospital was conducted to analyze the mid-term and long-term clinical efficacy of adalimumab combined with glucocorticoids in the treatment of refractory uveitis.MethodsPatients who visited the Department of Ophthalmology of the Second Affiliated Hospital of Nanchang University from January 2020 to December 2022 and were diagnosed with NIU according to the SUN diagnostic criteria were collected,and 30patients(45 eyes)who met the requirements were screened out through the inclusion and exclusion criteria.Ten cases(17 eyes)in the combined group received subcutaneous injection of adalimumab injection combined with oral glucocorticoids,and 10 cases(13 eyes)in the routine treatment group received oral glucocorticoids alone.10 cases(15 eyes)in the adalimumab group received subcutaneous injection of adalimumab injection,and the age,gender,best corrected visual acuity at the first visit and follow-up at 6m,12 m,and 15 m,anterior chamber flare classification,and macular center were recorded.Foveated retinal thickness,vitreous opacity score,recurrence times,glucocorticoid retention effect,adverse events.Finally,according to the results,SPSS25.0 software was used for statistical analysis.Results1.Baseline clinical characteristics(1)Baseline clinical characteristicsAmong the included patients,there were 12 males and 18 females,with an average age of 37.6 years,ranging from 8 to 74 years old.In the three groups,the gender composition was roughly the same(4 males and 6 females in the CT group,3males and 6 females in the combined group).7 females,5 males and 5 females in the ADA group).The average age of patients in the combination group and ADA group was lower than that of the patients in the CT group(47.7±17.19 years old in the CT group,32.6±14.35 years old in the ADA group,and 27.5±12.87 years old in the combined group).There were no statistically significant differences among the three groups in terms of age,sex,and disease history.2.Changes in ophthalmic indicatorsBCVA: BCVA in the combination group increased from baseline(0.55±0.19)Log MAR to(0.11±0.14)Log MAR.BCVA in CT group increased from baseline(0.6±0.14)Log MAR to(0.39±0.17)Log MAR,ADA group BCVA increased from baseline(0.51±0.17)Log MAR to(0.22±0.19)Log MAR,combined group and ADA The curative effect of the combination group was significantly better than that of the CT group.The grading of anterior chamber flash: All observation time points of anterior chamber inflammation in the three groups were significantly improved compared with the baseline(all P values were less than 0.05).Both the combination group and the ADA group had better curative effects than the CT group,and the combination group was better than the ADA group.The difference between the two groups was statistically significant(all P values were less than 0.05),and the improvement of anterior chamber inflammation in the combined group at 6 m was significantly better than that at other observation time points.Vitreous turbidity score: The vitreous inflammation in the combination group was significantly better than the baseline at each observation time point(all P values were less than 0.05),and the vitreous inflammation at 6m and 12 m in the CT group was significantly better than the baseline(all P values were less than 0.05),but Both the combined group and the ADA group had better curative effects than the CT group,and the curative effect of the combined group was better than that of the ADA group.Significant improvement was observed at several observation time points.In the CT group,when the observation time point was 15 m,there was no change in vitreous inflammation compared with that at 12 m.CMT: The CMT of the three groups was significantly reduced at each time point of observation compared with the baseline(all P values were less than 0.05).However,both the combined group and the ADA group had better curative effects than the CT group,and the differences between the two groups were statistically significant(all P values were less than 0.05).And at 6m,the CMT of the combined group was significantly reduced compared with other observation time points.3、Recurrence: The number of recurrences in the combination group was less than that in the CT group and the ADA group,and the difference between the two groups was statistically significant(all P values were less than 0.05).4、Glucocorticoid amount: The dose of glucocorticoids in the combination group was reduced from baseline(45±11.79)mg/day to(4±3.76)mg/day,and the dose of hormones in CT group was reduced from baseline(46±11.97)mg/day to(13.5 ±6.26)mg/day,the dose of the combination group was significantly less than that of the CT group at 15 mg(P value less than 0.05).5、Adverse reactions: There was no statistically significant difference in adverse reactions between the two groups(all P values were less than 0.05).ConclusionAdalimumab can help reduce the inflammatory activity of refractory uveitis and reduce the dosage of glucocorticoids. |
PDF Full Text Request