ppharmПедиатрическая фармакологияPediatric pharmacology1727-57762500-3089Издательство «ПедиатрЪ»10.15690/pf.v13i4.1605ppharm-1439Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЭффективность адалимумаба при хроническом переднем увеите, ассоциированном с ювенильным идиопатическим артритом и резистентным к терапии метотрексатом: ретроспективное исследование серии случаевThe Efficiency of Adalimumab in Cases of Chronic Methotrexate-Resistant Juvenile Idiopathic Arthritis-Associated Anterior Uveitis: Retrospective Case Series Studyhttps://orcid.org/0000-0002-0971-2018ГайдарЕ. В.GaidarE. V.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-1180-8086КостикМ. М.KostikM. M.

кандидат медицинских наук, доцент кафедры госпитальной педиатрии,194100, Санкт-Петербург, ул. Литовская, д. 2

St. Petersburg

kost-mikhail@yandex.ruhttps://orcid.org/0000-0002-6834-1413ДубкоМ. Ф.DubkoM. F.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-3703-4920МасаловаВ. В.MasalovaV. V.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0001-6778-4127СнегирёваЛ. С.SnegirevaL. S.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-0911-7817ИсуповаЕ. А.IsupovaE. A.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0001-6758-6999НикитинаТ. Н.NikitinaT. N.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-6924-8405СерогодскаяЕ. Д.SerogodskayaE. D.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-8683-4270КалашниковаО. В.KalashnikovaO. V.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0001-5776-1490ЧасныкВ. Г.ChasnykV. G.

Санкт-Петербург

St. Petersburg

Санкт-Петербургский государственный педиатрический медицинский университетРоссияSt. Petersburg State Pediatric Medical UniversityRussian Federation201614112016134340344Copyright © Гайдар Е.В., Костик М.М., Дубко М.Ф., Масалова В.В., Снегирёва Л.С., Исупова Е.А., Никитина Т.Н., Серогодская Е.Д., Калашникова О.В., Часнык В.Г., 20162016Гайдар Е.В., Костик М.М., Дубко М.Ф., Масалова В.В., Снегирёва Л.С., Исупова Е.А., Никитина Т.Н., Серогодская Е.Д., Калашникова О.В., Часнык В.Г.Gaidar E.V., Kostik M.M., Dubko M.F., Masalova V.V., Snegireva L.S., Isupova E.A., Nikitina T.N., Serogodskaya E.D., Kalashnikova O.V., Chasnyk V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pedpharma.ru/jour/article/view/1439

Увеит, ассоциированный с ювенильным идиопатическим артритом (ЮИА), может быть причиной не только снижения остроты зрения, но и слепоты. При этом у некоторых больных терапия метотрексатом не позволяет предупредить развитие этих осложнений.

Цель исследования

Цель исследования: изучить эффективность и безопасность применения ингибитора фактора некроза опухоли адалимумаба у пациентов с ЮИА-ассоциированным увеитом.

Методы

Методы. Проведено ретроспективное неконтролируемое исследование серии случаев. Результаты применения адалимумаба оценивали у пациентов с ЮИА-ассоциированным хроническим передним увеитом, которых наблюдали не менее 1 года до и после начала применения адалимумаба. Препарат назначали по причине прогрессирующего и/или рецидивирующего течения увеита, резистентного к терапии метотрексатом.

Результаты

Результаты. Осуществлен анализ историй болезни 36 детей с ЮИА-ассоциированным увеитом. Активный увеит на момент начала терапии адалимумабом был диагностирован у 30 (83%) пациентов. У пациентов с активным увеитом ремиссия была достигнута в 29 из 30 случаев через 2 (2; 12) нед. Обострение увеита развилось у 11 (31%) пациентов через 28 (13; 69) нед от начала терапии адалиму- мабом. Применение адалимумаба привело к снижению частоты обострений с 4 (1; 9) до 0 (0; 1) случаев в год на одного пациента (р < 0,001), уменьшению доли пациентов, получавших местные глюкокортикостероиды (с 83 до 8%). Не обнаружено различий в достижении ремиссии и снижении частоты обострений в зависимости от пола пациентов, вовлечения в дебюте болезни одного или обоих глаз, серопозитивности по антинуклеарному фактору, типа увеита, характера суставного поражения.

Заключение

Заключение. Адалимумаб способствует достижению быстрой и продолжительной ремиссии ЮИА-ассоциированного увеита, резистентного к терапии метотрексатом.

Background

Background: Juvenile idiopathic arthritis (JIA) associated uveitis may be the cause of not only visual acuity decrement, but also blindness. At the same time, in some patients therapy with methotrexate can not prevent the development of these complications.

Objective

Objective: Our aim was to investigate the efficiency and safety of using a tumor necrosis factor inhibitor (adalimumab) in patients with JIA-associated uveitis.

Methods

Methods: We conducted a retrospective single-arm study of a series of cases. The results of using adalimumab were evaluated in patients with JIA-associated chronic anterior uveitis, who have been under observation for no less than 1 year before and after starting using adalimumab. The latter was prescribed due to progressing and/or recidivous methotrexate-resistant uveitis.

Results

Results: We have analyzed clinical case records of 36 children with JIA-associated uveitis. At the start of therapy with adalimumab, actual uveitis was diagnosed in 30 (83%) patients. Remission was achieved in 29 of 30 cases in 2 (2; 12) weeks in patients with actual uveitis. 11 (31%) patients had a uveitis exacerbation 28 (13; 69) weeks after adalimumab therapy started. Adalimumab reduced the exacerbation frequency from 4 (1; 9) to 0 (0; 1) exacerbations per year for one patient (p < 0,001), and reduced the proportion of patients who were treated with topical glucocorticosteroids (from 83 to 8%). There were no differences (in achieving remission and reducing exacerbation frequency) with regard to patients’ sex, involvement of one or both eyes in the disease onset, antinuclear factor seropositiveness, uveitis type and character of joints affection.

Conclusion

Conclusion: Adalimumab promotes fast and long-lasting remission of JIA-associated methotrexate-resistant uveitis.

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The authors declare that there are no conflicts of interest present.