Update on the systemic management of noninfectious uveitis in children and adolescents.

Abstract

Noninfectious uveitis (NIU) in children and adolescents is a rare but treatable cause of visual impairment in children. Treatments for pediatric NIU and their side effects, along with the risks of vision loss and the need for long-term disease monitoring, pose significant challenges for young patients and their families. Treatment includes local and systemic approaches and this review will focus on systemic therapies that encompass corticosteroids, conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and biological disease-modifying antirheumatic drugs (bDMARD). Treatment is generally planned in a stepwise approach. Methotrexate is well-established as the preferential csDMARD in pediatric NIU. Adalimumab, an antitumor necrosis factor (TNF) agent, is the only bDMARD formally approved for pediatric NIU and has a good safety and efficacy profile. Biosimilars are gaining increasing visibility in the treatment of pediatric NIU. Other bDMARD with some evidence in literature for the treatment of pediatric NIU include infliximab, tocilizumab, abatacept, rituximab and, more recently, Janus kinase inhibitors. Important aspects of managing children on these systemic therapies include vaccination issues, risk of infection, and psychological distress. Also, strategies need to address regarding primary nonresponse/secondary loss of response to anti-TNF treatment, biological switching, and monitoring regimens for these drugs. Optimal management of pediatric uveitis involves a multidisciplinary team, including specialist pediatric uveitis and rheumatology nurses, pediatric rheumatologists, psychological support, orthoptic and optometry support, and play specialists.

• Authors: Inês Leal, Laura R Steeples, Shiao Wei Wong, Chiara Giuffrè, Sasa Pockar, Vinod Sharma, Elspeth K Y Green, Janine Payne, Nicholas P Jones, Alice Sieu Eng Chieng, Jane Ashworth
• Journal: Survey of ophthalmology (Surv Ophthalmol) 2024 Jan-Feb Vol. 69 Issue 1 Pg. 103-121 ISSN: 1879-3304 [Electronic] United States
• PMID: 36682467 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2023. Published by Elsevier Inc.

Chemical References

• Biosimilar Pharmaceuticals
• Tumor Necrosis Factor Inhibitors
• Antirheumatic Agents
• Adrenal Cortex Hormones

Topics

• Humans
• Child
• Adolescent
• Biosimilar Pharmaceuticals (therapeutic use)
• Tumor Necrosis Factor Inhibitors (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Uveitis (drug therapy)
• Adrenal Cortex Hormones (therapeutic use)