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Rula Hajj-ali, Maria Choudhary, Andrew Zeft, Steven Spalding, Sunil Srivastava, Careen Lowder; Effectiveness of anti-Tumor Necrosis Factor agents in Pediatric Population with Uveitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5191.
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Anti-tumor necrosis factor (anti-TNF) agents play an important role in controlling inflammation associated with non-infectious uveitis. Most commonly used agents include infliximab, adalimumab and etanercept. We compared these three agents in the pediatric population with non-infectious uveitis that is resistant to conventional immunosuppressive therapy.
A retrospective chart review of pediatric patients < 18 years old , with non-infectious uveitis followed at Cole Eye Institute between the year 2003 to 2011. All patients with non-infectious uveitis on anti-TNF agents were included in the study. Primary outcomes included achieving sustained remission (SR, defined as absence of inflammation for at least 3 consecutive months on a prednisone (or its equivalent) dose of 10 mg or less), time to SR and duration of SR. Proportional hazard regression model was used for sustained remission analysis where as categorical data was analyzed using the Chi-square tests.
The study cohort consisted of thirty eight patients consisting of 29 (76.3%) females and 9 (23.7%) males with a mean age of 11.2 (range: 3 - 17) years at the time of start of anti-TNF. Out of these, 23 (60.5%) had anterior uveitis, 4 (10.5%) had intermediate, 3 had posterior (7.9%) and 8 (21.1%) had panuveitis. 5 patients were on etanercept, 21 on infliximab and 12 on adalimumab. The mean duration to achieve SR was 8.46 (SD: 10.3) months for patients on etanercept, 11.42 (SD: 17.24) months on infliximab, and 12.86 (SD: 17.65) months on adalimumab (p = 0.96) (Figure 1). 80% patients on etanercept, 75% on infliximab and 81.3% on adalimumab were able to achieve SR (p = 0.88). SR was maintained for a mean duration of 28.7 (SD: 20.1) months on infliximab, 11.3 (SD: 10.2) months on adalimumab and 12.3 (SD: 6.5) months on etanercept (p = 0.043). The mean dose of infliximab at which SR was achieved was 6.7 mg/kg (SD: 3.1) at mean dosing interval of 3.6 (SD; 2.4) weeks.
Anti-TNF agents are effective in controlling inflammation in pediatric patients with non-infectious uveitis. Patients on infliximab tend to do better than those on etanercept and adalimumab by maintaining disease control for a longer period.
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