난치성 포도막염에서 아달리무맙 치료 효과
The Effect of Adalimumab on Refractory Uveitis
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목적: 전신 스테로이드나 면역억제제 치료 중에도 반복하여 재발하는 난치성 포도막염에서 Adalimumab (Humira®, AbbVie, Chicago, IL, USA)을 사용하여 치료 결과를 평가하고 효용성을 알아보고자 하였다. 대상과 방법: 비감염성 난치성 포도막염으로 Adalimumab 주사치료를 시행한 환자들을 대상으로 후향적으로 임상양상을 비교 분석하였다. 기저질환, 포도막염 양상, 병용치료 약물의 유무, 기존 치료로 발생한 부작용을 조사하였고 치료 전후의 전방과 유리체강 내세포 및 혼탁, 중심황반두께 및 최대교정시력을 비교하였다. 염증과 황반부종의 재발 유무, 병용치료 약물의 조절 여부, 이상반응 발생 사례를 확인하여 Adalimumab 투여의 안전성과 효용성을 평가하였다. 결과: Adalimumab 투여 전 유병기간은 평균 55.4개월(13-121개월)이었으며 주사 후 추적 관찰 기간은 평균 9.2개월(6-18개월)이었다. 18명 30안 모두에서 전신 스테로이드 사용을 중단할 수 있었으며 염증 완화가 확인되었다. 전방과 유리체강내 염증, 최대교정시력은 유의한 호전을 보였으며 중심황반두께는 차이를 보이지 않았다. 5안에서 포도막염의 재발이 발생하였으나 4안은 테논낭하 스테로이드주입술로 염증 조절이 가능하였으며, 1안은 methotrexate 병용 투여 후 조절이 가능했다. Adalimumab 투약 중 발생한 이상 반응은 두드러기(2명)와 주사부위 반응(1명)이 발생하였으며 주사부위 반응 1명은 투약을 중단해야 했다. 결론: Adalimumab은 난치성 포도막염 환자들에서 염증을 완화시키고 전신 스테로이드 투약을 줄일 수 있는 효과적인 치료법이다.
Abstract
Purpose: To assess the efficacy and safety of Adalimumab (Humira®, AbbVie, Chicago, IL, USA) for repeated refractory uveitis during systemic steroid or immunosuppressive therapy. Methods: We retrospectively reviewed clinical records on 30 eyes of 18 patients with non-infectious refractory uveitis who underwent Adalimumab injection therapy from December 2017 to July 2019. The therapeutic effect was assessed based on intraocular inflammation grade, central macular thickness, and best corrected visual acuity, and the efficacy was assessed based on control of inflammation and macular edema, as well as corticosteroid sparing effects. The safety was assessed based on adverse events. Results: The mean duration of uveitis at baseline was 55.4 months (13-121 months) and the mean follow-up was 9.2 months (6-18 months). All 30 eyes of 18 patients stopped using systemic steroids and maintained clinical quiescence. Anterior chamber inflammation, vitreous inflammation, and best corrected visual acuity showed significant improvement, and there was no difference in central macular thickness. Uveitis recurred in 5 eyes, but 4 eyes showed controlled inflammation after single posterior sub-tenon steroid injection. One eye was controlled after methotrexate co-administration. Ulticaria (two patients) and injection- site reaction (one patient) were reported as adverse events. Conclusions: Adalimumab is an effective treatment for decreasing inflammatory activity and reducing corticosteroid burden in refractory uveitis.
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