Efficacy and Safety of Adalimumab in Patients with Behçet Uveitis: A Systematic Review and Meta-Analysis

To examine the long-term efficacy and safety of adalimumab (ADA) in patients with Behçet uveitis (BU). A systematic review and meta-analysis of observational studies was performed. Pooled results are presented as mean difference or standardized mean difference (std diff) and 95% confidence intervals (CI). Visual acuity (VA), intraocular inflammation grade, central macular thickness, corticosteroid (CS) sparing effect and adverse events were evaluated. Ten studies were included finally for quantitative and qualitative synthesis. ADA therapy resulted in 0.124 (95%CI: 0.084, 0.165) logMAR improvement in VA. In addition, ADA therapy resulted in decreased grade of intraocular inflammation [std diff, −1.187 (95%CI: -1.508, -0.866)] and macular thickness [std diff, −0.564 (95%CI: -0.843, -0.286)] and caused a decrease in CS dosage [std diff, −1.809 (95%CI: -2.420, -1.198)]. The pooled rate of overall adverse events for ADA in 301 patients was 8.5% (95%CI: 0.039, 0.177). ADA is an efficient therapy that improves VA and controls intraocular inflammation, macular edema and retinal vasculitis. As the disease exposure time increased, improvement in VA was less. The safety and CS-sparing effect of ADA were demonstrated with few adverse effects. The results provided evidence that ADA can be used safely and efficiently as the first-line drug in patients with BU.

本研究旨在探讨阿达木单抗（adalimumab, ADA）用于白塞病葡萄膜炎（Behçet uveitis, BU）患者的长期疗效与安全性。本研究对观察性研究开展系统评价与荟萃分析，合并效应以均数差或标准化均数差（std diff）及95%置信区间（CI）呈现。本研究评估了视力（visual acuity, VA）、眼内炎症分级、中心黄斑厚度、糖皮质激素（corticosteroid, CS）节约效应及不良事件。最终纳入10项研究进行定量与定性综合分析。
阿达木单抗治疗可使视力提升0.124（95%CI: 0.084, 0.165）logMAR。此外，阿达木单抗治疗可降低眼内炎症分级[标准化均数差：-1.187（95%CI: -1.508, -0.866）]及黄斑厚度[标准化均数差：-0.564（95%CI: -0.843, -0.286）]，同时可降低糖皮质激素用量[标准化均数差：-1.809（95%CI: -2.420, -1.198）]。针对301例患者的阿达木单抗合并总体不良事件发生率为8.5%（95%CI: 0.039, 0.177）。
阿达木单抗是一种高效治疗方案，可改善视力、控制眼内炎症、黄斑水肿及视网膜血管炎。随着药物暴露时间延长，视力改善程度逐渐降低。本研究证实了阿达木单抗的安全性与糖皮质激素节约效应，且不良事件发生率较低。本研究结果提供证据支持阿达木单抗可作为白塞病葡萄膜炎患者安全有效的一线治疗药物。