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Rebecca S. Hunter, Danielle Ledoux, Ann-Marie Lobo; Outcomes Of TNF Alpha Inhibitor Therapy In Juvenile Idiopathic Arthritis Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2765.
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Juvenile idiopathic arthritis (JIA) associated uveitis is a blinding disease with severe visual impairment in up to 30% of patients. Immunosuppressive therapies (IMT) such as antimetabolites have been used to control ocular inflammation, but many patients have recalcitrant uveitis. Tumor necrosis factor alpha (TNF) inhibitors have been used for refractory ocular inflammation. We present visual outcomes and rates of adverse events in a combined population of JIA uveitis patients treated with TNF inhibitor therapy from two tertiary care referral centers.
A retrospective chart review of all patients diagnosed with JIA associated uveitis in the Uveitis Service at Massachusetts Eye and Ear Infirmary and the pediatric ophthalmology service at Children’s Hospital Boston between 2006 and 2011 was performed. Age at diagnosis, visual acuity, number and types of medications, and complications were recorded. Inclusion criteria included diagnosis of JIA prior to age 16 with documented uveitis and follow up period greater than 6 months.
121 eyes of 62 patients met diagnostic criteria for JIA uveitis. The mean age at diagnosis was 3.9. Median length of follow up was 4 years. 32 patients were treated with at least one TNF inhibitor; 18 with adalimumab, 20 with infliximab, 8 with etanercept and 5 with other TNF inhibitors. Of the 22 patients on a TNF inhibitor at last follow up, 77% were on combined treatment with an antimetabolite. TNF inhibitor therapy was discontinued in 4 patients with quiescent disease; 2 of these patients subsequently developed recurrence. 4/32 patients failed 1 or more TNF inhibitors. An average of 1.7 (range 1-5) TNF inhibitors was used per patient. Mean logMAR visual acuity was 0.18 (~20/29) at the initial visit and 0.19 (~20/30) at the last recorded visit. 69% of patients were quiescent at last follow up. 91% of patients had visual acuity of 20/40 or better in one eye at last follow up. Adverse reactions, including allergy or medication intolerance were noted in 3/18 patients on adalimumab and 6/21 patients on infliximab.
Low tolerance for ocular inflammation combined with advances and early initiation of IMT may prevent severe vision loss and ocular complications historically associated with JIA uveitis. TNF inhibitor therapies are useful in the treatment of recalcitrant JIA uveitis with good visual outcomes and low rates of adverse effects.
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