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Deshka Doycheva, Christoph M. Deuter, Gunnar Blumenstock, Nicole Stuebiger, Manfred Zierhut; Immunomodulatory Therapy with Tumor Necrosis Factor alpha Inhibitors in Pediatric Patients with Juvenile Idiopathic Arthritis-associated Uveitis - Long-term Results. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2760.
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To assess the long-term efficacy and tolerability of tumor necrosis factor alpha (TNFα) inhibitors in the therapy of children with juvenile idiopathic arthritis (JIA) associated uveitis.
Pediatric patients with JIA-associated uveitis who were treated with TNFα inhibitors and who had a follow-up of at least 2 years were retrospectively analyzed. Main outcome measures were improvement of inflammatory activity of uveitis, topical steroid-sparing potential and long-term side effects.
Thirty-one patients (12 male, 19 female) with a mean follow-up of 53 months (range: 24-129 months) were included in the study. Twenty-three patients were treated with adalimumab, 5 patients with infliximab and 3 patients with etanercept. Improvement of uveitis with a decrease of inflammatory activity was found in 20/31 children (65%) after one year and in 21/29 children (72%) after two years of treatment. A topical steroid-sparing effect was observed in 21/29 patients (72%) after one year and in 21/27 patients (78%) after two years of therapy. Relapses of uveitis occurred in 19/31 children (61%) after a mean time of 19 months.Mean duration of anti-TNFα treatment was 49 months (range: 14-126 months). In 4 patients (13%) the therapy was stopped because of inactivity of uveitis. Re-treatment with TNFα blocking agents due to uveitis recurrences was needed in 2 of these patients. Treatment-related side effects were observed in 9/31 patients (29%) with a rate of 0.10 per patient-year.
Our study shows that TNFα inhibitors are effective and well tolerated drugs in the treatment of JIA-associated uveitis in children. Long-term therapy is necessary for maintaining the inflammatory control, achieved with TNFα blocking agents.
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