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Michael Lewen, Monte Mills, Melissa Lerman; Uveitis Reactivation in Children Treated with Tumor Necrosis Factor-α Inhibitors. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2518.
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To evaluate reactivation of pediatric uveitis following treatment with TNF-alpha inhibition (anti-TNFα).
We retrospectively assessed children (≤18 years) with non-infectious uveitis who achieved quiescence while receiving anti-TNFα at The Children’s Hospital of Philadelphia (January, 2000-July, 2012). Reactivation was defined as redevelopment of “active” uveitis. Kaplan-Meier (KM) methods were used to calculate the rates of reactivation while still on treatment (primary outcome) and following complete discontinuation of anti-TNFα (secondary outcome). Variables were evaluated for their association with failure (reactivation).
Of the 136 children and adolescents treated for uveitis, 39 met criteria for assessment of the primary, and 19 met criteria for assessment of the secondary outcome. Almost two thirds of subjects were female, almost half carried systemic diagnoses of Juvenile Idiopathic Arthritis, and the majority were treated with infliximab. The KM estimated proportion who failed within 12 months was 27.8% (95% confidence interval [95% CI]: 15.9-45.8%). The estimated probability of failure within 12 months was higher following discontinuation of anti-TNFα (63.8% [95% CI: 38.9-87.7%]) relative to before discontinuation (21.6% [95% CI: 10.8-40.2%]). Amongst those who discontinued anti-TNFα, the likelihood of failure was significantly lower for those treated with infliximab (vs. adalimumab) (Hazard Ratio [HR] 0.07, 95% CI: 0.01-0.46). Older age at onset of ocular disease was associated with a significant increase in the hazard of failure (HR 1.32, 95% CI: 1.03-1.69). The duration of remission-on-medication did not significantly affect the likelihood of failure.
The durability of the response to anti-TNFα is limited in those children who remain on drug following achievement of uveitis quiescence. It is poorly sustained in those who discontinue anti-TNFα - with the majority having uveitis reactivation. These data suggest that infliximab results in a more durable remission-off-medication than does adalimumab. Results from this small cohort did not support the notion that maintenance of remission-on-medication for a longer duration decreases the likelihood of later reactivation.
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