The efficacy and safety of TNF inhibitor (golimumab) as salvage treatment in patients with refractory noninfectious uveitis

摘要

Background Tumor necrosis factor inhibitor (TNFi) is recently reported to treat noninfectious uveitis (NIU) effectively. However, as a new kind of TNFi, golimumab is just on the market in China for several years, and its administration for NIU treatment lacks sufficient evidence. Therefore, the current study aimed to investigate the efficacy and safety of golimumab in refractory NIU patients. Methods Thirty NIU patients with 49 affected eyes refractory to conventional treatments (corticosteroids and immunosuppressive agents) were consecutively enrolled. They received treatment of TNFi (50 mg golimumab every 4 weeks) for at least 6 months. The anterior chamber cell grade, vitreous haziness grade, central macular thickness, and visual acuity were evaluated at baseline, month (M) 1, M3, and M6. Results After treatment, the anterior chamber cell grade declined from baseline (0.6 +/- 0.7) to M6 (0.3 +/- 0.5) (P < 0.001); the vitreous haziness grade decreased from baseline (1.2 +/- 1.2) to M6 (0.4 +/- 0.5) (P < 0.001); meanwhile, the central macular thickness also reduced from baseline (351.4 +/- 90.8 mu m) to M6 (271.8 +/- 54.4 mu m) (P < 0.001). In terms of visual acuity (LogMAR), it showed a declined trend from baseline (0.5 +/- 0.3) to M6 (0.4 +/- 0.2), but without statistical significance (P = 0.096). Subgroup analyses revealed that TNFi history related to decreased golimumab efficacy. In addition, 13.3 of patients had adverse events, including elevated liver enzymes (6.7), fatigue (3.3), and rash (3.3). Conclusion Golimumab is effective and safe for refractory NIU treatment, while a large-scale trial is still needed for verification.