抗病毒藥物使用對於巨細胞病毒前葡萄膜炎治療之結果影響: 統合分析與臨床試驗計畫書

Abstract

背景： 巨細胞病毒前葡萄膜炎可能以急性、反覆發作的青光眼睫狀體炎危象或是慢性虹彩炎來表現，也有部分角膜內皮炎案例與巨細胞病毒感染有關。根據先前案例報告研究，系統性或局部性抗病毒藥物治療可以有效治療前房發炎。然而，對於巨細胞病毒前葡萄膜炎，尚未有標準治療。 此篇統合分析主要是為整合與評估不同路徑的抗病毒藥物療法對於巨細胞病毒前葡萄膜炎之結果影響。並計畫以此設計臨床試驗以解決相關問題。 方法： 本研究於西元2019年11月15日於資料庫進行文獻搜尋，並以前房發炎反應緩解作為主要療效指標，復發次數與復發時間等做為次要療效指標。 結果： 有四篇回溯性、非隨機分派的觀察性研究符合納入標準而進行後續統合分析，文獻中皆描述可緩解巨細胞病毒前葡萄膜炎的前房發炎反應，但因無對照組資料可供比較驗證主要療效指標。然而次要療效指標中復發次數，可藉由以抗病毒藥物介入前的資料做為對照組，無論是系統性或局部性抗病毒藥物，使用後皆可顯著降低復發次數(p<0.00001) 臨床試驗： 局部抗病毒藥物(2%西美芬液)使用對於巨細胞病毒前葡萄膜炎治療之結果影響: 臨床試驗計畫書

Background: Patients with cytomegalovirus (CMV) anterior uveitis may have acute relapsing hypertensive uveitis (Posner-Schlossman syndrome) or present as chronic uveitis as Fuchs uveitis syndrome. Besides, some cases of corneal endotheliitis are related to CMV infection. Anti-CMV treatment are reported effective for resolution of CMV anterior infection, regardless of systemic, topical or intraocular treatment. However, there is no standard guideline for treatment of CMV anterior uveitis yet. Objective: The aim of this meta-analysis was to assess and summarize the updated evidence on the outcomes of treatment with any route of anti-CMV treatment for CMV anterior uveitis. And plan to design further clinical trial to conduct unsolved problem in the treatment of CMV anterior uveitis. Materials and methods: We conducted a systematic search on November 15, 2019, of electronic databases (PubMED, and The Cochrane Library) and clinical trial registers. The primary outcome was uveitis resolution as measured by SUN criteria, while the secondary outcomes included number of recurrences, time to recurrence, and etc. A meta-analysis was conducted on selected studies with appropriate clinical and methodological homogeneity. Results: Nine studies were included and reviewed at first. Four retrospective nonrandomized clinical trials were eligible for meta-analysis. All studies illustrated effective for inflammation resolution, but no comparable data could be pooled for further quantitative synthesis. In addition, anti-CMV therapy, either systemic or topical route, is effective for recurrence reduction of uveitis flares up while comparing to the status prior to anti-CMV therapy. (p<0.00001) Protocol design: Outcomes of treatment with topical 2% ganciclovir for cytomegalovirus (CMV) anterior uveitis: Protocol We plan to conduct the trial to confirm the efficacy of topical 2% ganciclovir for CMV anterior uveitis via randomized, placebo-controlled trail.