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Kruti Dajee, Roshni Patel, Cassidy Tang, Monica Bratton, Yu-Guang He; Use of Systemic Immune Suppressive Agents in Pediatric Uveitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6208.
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Pediatric uveitis is a blinding disease and is challenging to treat in the pediatric population. There are few FDA approved systemic immunosuppressive medications approved for use in pediatric uveitis. The purpose of this study is to demonstrate efficacy and safety of these agents in pediatric uveitis.
A retrospective chart review was conducted at Children’s Medical Center from 2001-2014. Ophthalmology and rheumatology visits of 35 patients were reviewed. To demonstrate efficacy of immunosuppressive agents, visual acuity, anterior chamber cell and flare, ocular complications, and dependency on topical and oral corticosteroids were recorded. To demonstrate safety, serious and minor adverse events and effect on pediatric growth and well-being were analyzed.
Systemic immunosuppressives used for treatment included methotrexate (40.0%), adalimumab (17.1%), mycophenolate mofetil (5.7%), and infliximab (2.9%). The mean follow up period was 36.8 months. Mean visual acuity at treatment initiation was 20/80, which improved to 20/50. Average anterior chamber cell and flare improved (-1.08 and -0.76 respectively). Dependency on oral steroids reduced from 8.6% to 5.7%. Frequency of topical steroids improved from 6.7 times a day to 2.6 times a day at the last follow up visit (p=0.0001, CI 2.42 to 5.70). An overall reduction in number of ocular complications was noted from 80.0% to 60.0%. 11.4% patients were noted to have serious adverse events that led to discontinuation of the immunosuppressive agent. 51.4% patients reported minor adverse events. The average height percentile was 55.52 (SD=30.59), weight was 68.41 (SD=30.15), and BMI was 68.94 (SD=33.40).
This study aims at providing a comprehensive review on the safety and efficacy of the use of systemic immunosuppressives in the management of pediatric uveitis. While other major studies have detailed characteristics and complications occurring with pediatric uveitis; to our knowledge, this is the first study of its kind to focus on the use of immunosuppressives in pediatric uveitis at a large tertiary referral center. Our study shows that the use of immunosuppressive agents is efficacious in improving visual outcomes, decreasing the need for topical steroids, decreasing inflammation and ocular complications. They are also safe given the limited number of adverse events with no significant effect on pediatric well-being.
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