TY - JOUR T1 - Response of Pediatric Uveitis to Tumor Necrosis Factor-α Inhibitors JF - The Journal of Rheumatology JO - J Rheumatol SP - 1394 LP - 1403 DO - 10.3899/jrheum.121180 VL - 40 IS - 8 AU - Melissa A. Lerman AU - Jon M. Burnham AU - Peter Y. Chang AU - Ebenezer Daniel AU - C. Stephen Foster AU - Sean Hennessy AU - Douglas A. Jabs AU - Marshall M. Joffe AU - R. Oktay Kaçmaz AU - Grace A. Levy-Clarke AU - Monte D. Mills AU - Robert B. Nussenblatt AU - James T. Rosenbaum AU - Eric B. Suhler AU - Jennifer E. Thorne AU - John H. Kempen Y1 - 2013/08/01 UR - http://www.jrheum.org/content/40/8/1394.abstract N2 - 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. ER -