Response of pediatric uveitis to tumor necrosis factor-α inhibitors.

Abstract

OBJECTIVE:

To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis.

METHODS:

We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses.

RESULTS:

Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%-87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%-76%). Diagnoses of JIA or AU were associated with greater likelihood of success, as was the oligoarticular subtype among JIA cases. In a multivariable model, compared to those with JIA-associated AU, those with neither or with JIA or AU alone had a 75%-80% lower rate of achieving quiescence under anti-TNF, independent of the number of immunomodulators previously or concomitantly prescribed. Uveitis reactivated within 12 months of achieving quiescence in 14% of those continuing anti-TNF (95% CI 6%-31%). The incidence of discontinuation for adverse effects was 8%/year (95% CI 1%-43%).

CONCLUSION:

Treatment with anti-TNF was successful and sustained in a majority of children with noninfectious uveitis, and treatment-limiting toxicity was infrequent. JIA-associated AU may be especially responsive to anti-TNF.

• Authors: Melissa A Lerman, Jon M Burnham, Peter Y Chang, Ebenezer Daniel, C Stephen Foster, Sean Hennessy, Douglas A Jabs, Marshall M Joffe, R Oktay Kaçmaz, Grace A Levy-Clarke, Monte D Mills, Robert B Nussenblatt, James T Rosenbaum, Eric B Suhler, Jennifer E Thorne, John H Kempen
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 40 Issue 8 Pg. 1394-403 (Aug 2013) ISSN: 0315-162X [Print] Canada
• PMID: 23818712 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Immunoglobulin G
• Receptors, Tumor Necrosis Factor
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab
• Etanercept

Topics

• Adalimumab
• Adolescent
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Arthritis, Juvenile (drug therapy, epidemiology)
• Child
• Child, Preschool
• Cohort Studies
• Comorbidity
• Etanercept
• Female
• Humans
• Immunoglobulin G (therapeutic use)
• Infant
• Infliximab
• Kaplan-Meier Estimate
• Male
• Receptors, Tumor Necrosis Factor (therapeutic use)
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Uveitis (drug therapy, epidemiology)
• Uveitis, Anterior (drug therapy, epidemiology)