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The effect of anti-tumor necrosis factor alpha agents on the outcome in pediatric uveitis of diverse etiologies.
- Source :
-
Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie [Graefes Arch Clin Exp Ophthalmol] 2018 Apr; Vol. 256 (4), pp. 801-808. Date of Electronic Publication: 2018 Feb 18. - Publication Year :
- 2018
-
Abstract
- Purpose: This study aimed to report the clinical outcome of children with uveitis treated with anti-tumor necrosis factor alpha (TNF-α) agents.<br />Methods: This included a retrospective cohort study. Children with uveitis treated with infliximab or adalimumab in 2008-2014 at five dedicated uveitis clinics were identified by database search. Their medical records were reviewed for demographic data, clinical presentation, ocular complications, and visual outcome. Systemic side effects and the steroid-sparing effect of treatment were documented.<br />Results: The cohort included 24 patients (43 eyes) of whom 14 received infliximab and 10 received adalimumab after failing conventional immunosuppression therapy. Mean age was 9.3 ± 4.0 years. The most common diagnosis was juvenile idiopathic arthritis-related uveitis (n = 10), followed by Behçet's disease (n = 4), sarcoidosis (n = 1), and ankylosing spondylitis (n = 1); eight had idiopathic uveitis. Ocular manifestations included panuveitis in 20 eyes (46.5%), chronic anterior uveitis in 19 (44.2%), and intermediate uveitis in 4 (9.3%). The duration of biologic treatment ranged from 6 to 72 months. During the 12 months prior to biologic treatment, while on conventional immunosuppressive therapy, mean visual acuity deteriorated from 0.22 to 0.45 logMAR, with a trend of recovery to 0.25 at 3 months after initiation of biologic treatment, remaining stable thereafter. A full corticosteroid-sparing effect was demonstrated in 16 of the 19 patients (84.2%) for whom data were available. Treatment was well tolerated.<br />Conclusions: Treatment of pediatric uveitis with anti-TNF-α agents may improve outcome while providing steroid-sparing effect, when conventional immunosuppression fails. The role of anti-TNF-α agents as first-line treatment should be further investigated in controlled prospective clinical trials.
- Subjects :
- Adolescent
Antirheumatic Agents therapeutic use
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Male
Retrospective Studies
Treatment Outcome
Uveitis etiology
Adalimumab therapeutic use
Arthritis, Juvenile complications
Behcet Syndrome complications
Infliximab therapeutic use
Tumor Necrosis Factor-alpha antagonists & inhibitors
Uveitis drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1435-702X
- Volume :
- 256
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie
- Publication Type :
- Academic Journal
- Accession number :
- 29455252
- Full Text :
- https://doi.org/10.1007/s00417-018-3928-6