RT Journal Article
SR Electronic
T1 Response of Pediatric Uveitis to Tumor Necrosis Factor-α Inhibitors
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1394
OP 1403
DO 10.3899/jrheum.121180
VO 40
IS 8
A1 Melissa A. Lerman
A1 Jon M. Burnham
A1 Peter Y. Chang
A1 Ebenezer Daniel
A1 C. Stephen Foster
A1 Sean Hennessy
A1 Douglas A. Jabs
A1 Marshall M. Joffe
A1 R. Oktay Kaçmaz
A1 Grace A. Levy-Clarke
A1 Monte D. Mills
A1 Robert B. Nussenblatt
A1 James T. Rosenbaum
A1 Eric B. Suhler
A1 Jennifer E. Thorne
A1 John H. Kempen
YR 2013
UL http://www.jrheum.org/content/40/8/1394.abstract
AB 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.