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Friederike Mackensen, Matthias Becker, Juergen Grulich-Henn, Thomas Lutz; Use of biologics in pediatric uveitis: changing treatment patterns. Invest. Ophthalmol. Vis. Sci. 2013;54(15):358.
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In 2010 we presented data of 3 european centers with a total of 475 children with uveitis. 182 were included from the uveitis center in Heidelberg. Here we could show that compared to previous studies from the US covering the years 1980-2005, where 6% received treatment with biologics, this increased to 8.8 % in the time period from 1990 to 2007. This was supposed to be due to changing treatment patterns since 2000. The aim of the current study was to analyse further change in treatment patterns and use of newer biologics in pediatric uveitis.
Database search. All children (<18 years) with uveitis seen in the interdisciplinary uveitis center from 08/2007 until 11/2012 were included. Medical treatment was evaluated. This was compared to the previously presented cohort of 457 children and also to a published cohort of 527 children from the US (Smith et al 2009). Parameters analyzed followed published recomendations (MIWGUC and SUN).
In the study period 301 children with uveitis were treated at the interdisciplinary uveitis center in Heidelberg. Anatomic localisation was posterior in 21 (7%), intermediate in 65 (21.6%), pan in 10 (3.3%) and anterior in 185 (61.5%). 41(13.6%) children recieved biologics during the studied period: 31 adalimumab (ADA), 8 Etanercept (ETA), 4 Infliximab (INFL), 3 Abatacept, and one Tocilizumab. Among those were 32 children with juvenile idiopathic arthritis (JIA) (78%). All 8 patients were put on ETAfor uncontrolled joint disease. Two patients developed uveitis and were switched to ADA or to abatacept (n=1 each). In the remaining 6 patients uveitis remained controlled during ETA treatment. The other biologics were started for activity of uveitis. Efficacy of treatment was seen in all patients looking at visual accuity, inflammatory activity or prednisone sparing effect at set time points. In the adalimumab group, 3 had secondary loss of efficacy and moved on to infliximab (n=2) or to abatacept (n=1). One patient subsequently also failed infliximab and changed to tocilizumab. Meaning that 5 children recieved more than 1 biologic during the studied period.
Frequency of biologic use further increased to 13.6% in the last 5 years as compared to 8.8% in the previous study. Especially in uveitis assciated to JIA, which generally is thought to be the most severe form of pediatric uveitis, this has helped to controll inflammation and improve and stabilize visual accuity.
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