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난치성 포도막염에서 인플릭시맵 치료 결과

The Efficacy of Infliximab in Refractory Uveitis

이동욱|조남천|김준형
대한안과학회 (The Korean Ophthalmological Society)|2016.01|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제57권 제1호|pp. 50-55

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키워드

TNF-αRefractory uveitisInfliximab
주제분류안과학

초록

목적: 적극적인 면역 억제 요법에도 반복 재발하는 난치성 포도막염 환자에서 anti TNF-α antibody인 Infliximab (Remicade®, Schering-Plough, Welwyn Garden City, UK)을 사용하여 그 치료 결과를 알아보고자 하였다. 대상과 방법: 난치성 포도막염으로 2002년부터 2011년까지 치료 받은 환자 30명 중 Infliximab을 사용한 환자 15명, 사용하지 않은 환자 15명의 의무 기록을 후향적으로 분석하였다. Infliximab을 투여 받은 군은 4주마다 5 mg/kg의 용량으로 3회에 걸쳐 정맥 주사하고 1주, 2주, 그 후 1개월마다 경과 관찰하였으며, 전방의 염증 세포가 0.5+ 이상일 때 재발로 정의하였다. 결과: Infliximab을 투여한 15명의 환자 중 14명의 환자에서 반응을 보였으며 1명의 환자에서는 반응이 없었다. Infliximab으로 치료 받은 환자에서는 1.1 ± 0.2회의 재발을 보였고, Infliximab으로 치료 받지 않은 환자에서는 3.1 ± 0.3회로 Infliximab을 투여한 환자군에서 유의하게 적은 재발 횟수를 보였다(p=0.022). 결론: 일반적인 약물 치료에 반응하지 않는 난치성 포도막염 환자에서 Infliximab은 효과적인 치료 방법으로 생각된다. 그러나 전향적 무작위 연구를 통해 Infliximab에 효과가 있는 포도막염군을 설정하는 것이 필요하리라 생각되며 용량 및 횟수에 대한 정확한 프로토콜이 나와야 할 것으로 사료된다.

Abstract

Purpose: To investigate the effectiveness of infliximab as treatment for refractory uveitis that recurred in spite of immunosuppressive agents. Methods: Thirty patients who were treated for refractory uveitis from 2002 to 2011 were included in this study. We retrospectively reviewed the medical records of 15 patients who were treated with Infliximab and 15 patients not treated with Infliximab. Infliximab was injected intravenously (5 mg/kg) 3 times every 4 weeks, and the patients were followed-up at 1 week, 2 weeks, and every month thereafter. Anterior chamber cell reaction with a score greater than 0.5+ was defined as recurrence of uveitis. Results: Among 15 patients treated with Infliximab, only one showed no response to the medication. The recurrence rate was significantly higher in patients receiving Infliximab treatment (1.1 ± 0.2 times) than in those not receiving Infliximab treatment (3.1 ± 0.3 times) (p=0.022). Conclusions: Infliximab can be used effectively on patients with refractory uveitis. However, a future prospective randomized study is needed to demonstrate the effectiveness of Infliximab and to determine an accurate protocol regarding dosage and number of injections.

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