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Estudo observacional retrospetivo sobre o efeito da terapêutica biológica na uveíte em idade pediátrica
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Introdução: A uveíte em idade pediátrica torna-se um desafio terapêutico quando refratária à terapêutica de primeira linha. Pelas complicações e morbilidade a que está associada, é fulcral conhecer a eficácia da terapêutica biológica.
Objetivos: Realizar uma análise descritiva dos doentes pediátricos sob terapêutica biológica por uveíte não infecciosa seguidos no Centro Hospitalar Universitário Lisboa Norte e avaliar aos 6 e 12 meses de follow-up a evolução da acuidade visual, pressão intraocular (mmHg), atividade inflamatória (segundo a SUN Grading Scheme) e terapêutica realizada, bem como utilizar de forma piloto a plataforma uveite.pt.
Metodologia: Estudo observacional retrospetivo unicêntrico com base nos dados extraídos da plataforma. Para análise descritiva foi definida a amostra A com todos os doentes com uveíte em idade pediátrica sob terapêutica biológica. Foi definido como subgrupo a amostra A1 de doentes que apresentam registos desde pré-tratamento e até 12 meses de follow-up.
Resultados: A amostra A inclui 14 doentes com idade média de 14,9 anos (± 4,2 anos). Dez doentes (71,4%) tinham o diagnóstico artrite idiopática juvenil e quatro (28,6%) uveíte idiopática. O fármaco mais utilizado foi o adalimumab (71,4%). Doze crianças (85,7%) não apresentaram atividade inflamatória da câmara anterior no registo mais recente. A amostra A1 considera 8 doentes. Ao fim de 12 meses, verificou-se alteração do valor médio da acuidade visual (0,8 em pré-tratamento vs 0,9, p 0,34), pressão intraocular (16,1mmHg vs 12,5mmHg, p 0,19) e atividade celular (0,9 vs 0,05, p 0,02). Constatou-se também uma diminuição da dose de corticosteróides orais neste período (12,0mg/dia vs 1mg/dia, p 0,44).
Conclusão: Verificou-se uma melhoria dos três parâmetros oculares medidos ao fim de 12 meses, sendo apenas a atividade celular estatisticamente significativa. O efeito poupador de corticosteróides foi parcial. Este projeto demonstra o vasto potencial da plataforma uveite.pt na investigação desta patologia.
Introduction: Pediatric uveitis becomes a therapeutical challenge when refractory to first-line therapy. Given its complications and morbidity, it is essential to study the efficacy of biological therapy. Objectives: Perform a descriptive analysis of pediatric patients undergoing biological therapy for non-infectious uveitis followed at Centro Hospitalar Universitário Lisboa Norte and evaluate at 6 and 12 months of follow-up their visual acuity, intraocular pressure (mmHg), inflammatory activity (according to the SUN Grading Scheme) and therapeutics performed, as well as being a pilot for studies using the uveite.pt platform. Methods: Observational retrospective single-centre study based on the data exctracted from the platform. For the descreptive analysis, it was defined a sample A with all patients with pediatric uveitis under biological therapy. A subgroup was defined as sample A1 with patients who had records from pre-treatment and up to 12 months of follow-up. Results: Sample A includes 14 patients with a mean age of 14.9 years (± 4.2 years). Ten patients (71.4%) were diagnosed with juvenile idiopathic arthritis and four (28,6%) had idiopathic uveitis. Twelve children (85.7%) do not have any activity of anterior chamber inflammation in the most recente record. Sample A1 includes 8 patients. After 12 months there was a change in the mean value of visual acuity (0.8 in pre-treatment vs 0.9, p 0.34), intraocular pressure (16.1mmHg vs 12.5mmHg, p 0.19) and cell activity (0.9 vs 0.05, p 0.02). There was also a decrease in the dose of oral corticosteroids during this period of follow-up (12.0mg/day vs 1mg/day, p 0.44) Conclusion: There was an improvement in the three ocular parameters measured after 12 months, only the cell activity being statistically significant. The corticoid sparing effect was partial. This project demonstrates the notable potential of the uveite.pt pt platform in research of uveitis and its therapeutics.
Introduction: Pediatric uveitis becomes a therapeutical challenge when refractory to first-line therapy. Given its complications and morbidity, it is essential to study the efficacy of biological therapy. Objectives: Perform a descriptive analysis of pediatric patients undergoing biological therapy for non-infectious uveitis followed at Centro Hospitalar Universitário Lisboa Norte and evaluate at 6 and 12 months of follow-up their visual acuity, intraocular pressure (mmHg), inflammatory activity (according to the SUN Grading Scheme) and therapeutics performed, as well as being a pilot for studies using the uveite.pt platform. Methods: Observational retrospective single-centre study based on the data exctracted from the platform. For the descreptive analysis, it was defined a sample A with all patients with pediatric uveitis under biological therapy. A subgroup was defined as sample A1 with patients who had records from pre-treatment and up to 12 months of follow-up. Results: Sample A includes 14 patients with a mean age of 14.9 years (± 4.2 years). Ten patients (71.4%) were diagnosed with juvenile idiopathic arthritis and four (28,6%) had idiopathic uveitis. Twelve children (85.7%) do not have any activity of anterior chamber inflammation in the most recente record. Sample A1 includes 8 patients. After 12 months there was a change in the mean value of visual acuity (0.8 in pre-treatment vs 0.9, p 0.34), intraocular pressure (16.1mmHg vs 12.5mmHg, p 0.19) and cell activity (0.9 vs 0.05, p 0.02). There was also a decrease in the dose of oral corticosteroids during this period of follow-up (12.0mg/day vs 1mg/day, p 0.44) Conclusion: There was an improvement in the three ocular parameters measured after 12 months, only the cell activity being statistically significant. The corticoid sparing effect was partial. This project demonstrates the notable potential of the uveite.pt pt platform in research of uveitis and its therapeutics.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Uveíte pediátrica Terapêutica biológica Artrite idiopática juvenil Uveíte idiopática Fármacos anti-TNF