Treatment of Pediatric Autoimmune Uveitis With Infliximab

Abstract

Purpose: : The treatment of refractory uveitis in children poses a special challenge, as the important systemic side effects of immunosuppressive regimens are often perceived as more damaging than the uveitis itself, in particular given their limited ability to produce complete remission. The present report illustrates our experience with infliximab, a TNFα antibody, and its efficacy and safety during treatment of refractory uveitis in children.

Methods: : Outcomes of five children with uveitis treated with infliximab were analyzed. Efficacy outcomes were measured as change in anterior chamber (AC) cells or change in dosage/number of other anti–inflammatory medications required to control the inflammation, recorded after 5 months of treatment. Safety outcomes were measured as any severe adverse event possibly related to infliximab therapy.

Results: : Three patients had idiopathic uveitis and two had Juvenile Idiopathic Arthritis (JIA)–associated uveitis, inadequately controlled with methotrexate and topical anti–inflammatory treatment, in addition, patients with JIA were also receiving cyclosporin and etanercept. The institution of infliximab resulted in successful uveitis treatment in all three patients with idiopathic disease, reducing AC cells to 0 and allowing for reduction of additional anti–inflammatory therapy. Conversely, patients with JIA–associated uveitis could not be succesfully treated with infliximab, one child required additional topical steroids to achieve remission and the other showed 2+ AC cells inspite of aggresive anti–inflammatory treatment. Despite successful uveitis control, infliximab administration was suspended in one of the patients with idiopathic disease due to development of pulmonary histoplasmosis, which was considered as possible adverse event.

Conclusions: : Infliximab was associated with successful inflammation control in patients with idiopathic uveitis, not so when treating patients with JIA–associated uveitis. The possible extraocular complications associated with this treatment mandate further evaluation of its risk–benefit ratio.

Keywords: autoimmune disease • uvea