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Meghan Berkenstock, Fei Yu, Deborah McCurdy, Gary N Holland; Infliximab Treatment of Chronic Anterior Uveitis in Children: Longitudinal Assessment of Cells and Flare. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1893.
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© ARVO (1962-2015); The Authors (2016-present)
Infliximab is a popular treatment for chronic anterior uveitis (CAU) in children, but published studies of its effect have been difficult to interpret because of non-standardized outcome measures and differential follow-up. Time-dependent reduction of anterior chamber cells and flare in general have been associated with a lower risk of disease-related adverse events (AE) in children with CAU; we therefore investigated the course of cells and flare in this population during infliximab therapy.
Retrospective review of 23 children (42 eyes) with CAU treated with infliximab. Data collected included age at uveitis onset, sex, associated systemic disease, duration of uveitis before start of infliximab, and from each ophthalmic examination, cells (per SUN criteria), flare (laser flare photometry), and presence of complications (uveitis- and drug-associated). Kaplan-Meier analyses were used to determine intervals to control of uveitis (cells <1+; 20% reduction in flare [for values >20 pu/msec] or an absolute value <20 pu/msec) and subsequent loss of control. Outcomes for cells and flare were analyzed separately.The eye was the unit of analysis.
Mean age at uveitis diagnosis was 4.48 yrs; mean duration of uveitis prior to start of infliximab was 5.43 yrs. Most patients were female (73.9%) and had JIA (56.5%). Median duration of treatment was 4 yrs. Median time to cells <1+ was 1.9 mos; median time to flare <20 pu/msec was 1.35 mos. Median time to loss of control based on cells (≥1+ after initial decrease to <1+) was 5.9 mos (incidence 14.8/100 eye-mo); median time to loss of control based on flare (≥20 pu/msec) was 14.0 mos (incidence 4.2/100 eye-mo). The only uveitis-associated complications during treatment were cataract (9 eyes) and posterior synechiae (1 eye). Infusion-related problems occurred in 3 children (anaphylactoid reaction, rash, and pruritus).
Standardized, time-dependent assessment of infliximab's effect on CAU in children can be performed with objective measures of inflammation and outcomes related to development of AE. Cells and flare can change independently. Within 2 mos, most patients achieved levels of cells, flare, or both that protect against AE. This study provides evidence that infliximab may lose effect over time. Vision-threatening AE were infrequent during treatment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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