Purchase this article with an account.
Maria M. Choudhary, Michelle Lin, Sunil K. Srivastava, Rula Hajj-Ali, Careen Lowder; Anti-Tumor Necrosis Factor (anti-TNF) Agents for treatment of Non-Infectious Uveitis in Children: Preliminary Report. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2763.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the safety and effectiveness of anti-TNF therapy for non-infectious uveitis in the pediatric population.
Retrospective chart review of children (age < 18 years) with non-infectious uveitis seen at a single institute from January 2006 to November 2011. There were a total of 27 patients and we have reviewed the records of 11 patients.
Our study population included eleven patients (21 eyes), 9 girls and 2 boys, with mean age of 11 years and a mean follow-up duration of 23 months. Diagnoses included: acute posterior multifocal placoid pigment epitheliopathy (1), juvenile idiopathic arthritis (4), psoriatic arthritis (1), Crohn's disease (1) and idiopathic uveitis (4). 6 patients were treated with infliximab and 5 with adalimumab. All patients were on concurrent methotrexate, and two patients were switched to mycophenolate mofetil (MMF). 6 patients had been on steroids prior to the start of anti-TNFs. Most common indications for anti-TNF therapy were failing methotrexate and corticosteroid dependency. 19 of 21 eyes had BCVA 20/100 or better at presentation. Five (45%) patients had steroid-induced cataract, 5 patients needed glaucoma and 2 required tube shunt. All but one patient achieved steroid-sparing remission. Six patients (9 eyes, 43%) had at least one relapse. The mean length to achieve inactive disease was 18 weeks. The mean length of steroid-sparing remission to first uveitis recurrence was 22 weeks. Probable causes for relapse include: anti-TNF tapering, ocular surgery, and missed immunosuppression doses. Anti-TNF related complications include hypersensitivity reaction to infliximab in one case and cellulitis in another. One patient developed lymphoma while on adalimumab and concurrent methotrexate.
Anti-TNFs are effective in the treatment of non-infectious uveitis and in achieving steroid-sparing remission in the pediatric population but one must be aware of complications including infections and malignancy.
This PDF is available to Subscribers Only