July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Title: Efficacy of abatacept treatment for severe, recalcitrant pediatric uveitis
Author Affiliations & Notes
  • Syeda Maryam Ahmed Naqvi
    Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio, United States
  • Virginia Miraldi Utz
    Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio, United States
  • Sabrina Bulas
    Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio, United States
  • Lovell Dan
    Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio, United States
  • Sarah Lopper
    Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio, United States
  • Adam H. Kaufman
    Cincinnati Childrens Hospital Medical Center, Cincinnati, Ohio, United States
  • Footnotes
    Commercial Relationships   Syeda Maryam Ahmed Naqvi, None; Virginia Utz, None; Sabrina Bulas, None; Lovell Dan, None; Sarah Lopper, None; Adam Kaufman, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 409. doi:
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      Syeda Maryam Ahmed Naqvi, Virginia Miraldi Utz, Sabrina Bulas, Lovell Dan, Sarah Lopper, Adam H. Kaufman; Title: Efficacy of abatacept treatment for severe, recalcitrant pediatric uveitis
      . Invest. Ophthalmol. Vis. Sci. 2018;59(9):409.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Data is limited on the treatment of recalcitrant, non-infectious uveitis in the pediatric population who have failed or have contraindications to TNF-alpha inhibitors. The objective of this study was to assess the efficacy of abatacept (ABT) as a primary or secondary biologic therapy for Juvenile Idiopathic Arthritis (JIA)-associated uveitis.

Methods : A retrospective review of 5 pediatric patients with JIA and refractory uveitis treated with ABT for > 9 months between December 30, 2002 and June 30, 2017 at Cincinnati Children’s Hospital Medical Center (CCHMC) was performed. Outcomes included control of uveitis and joint disease (% inactive) as well as reduction of topical steroid burden (% achieving <2 drops of prednisolone acetate/day). Ocular complications were assessed prior to and while on ABT.

Results : The patient cohort (N=5) had a mean age of 10.0+2.3 (range 7.3-13.5) years at start of ABT. Average follow up was 50.2+28.5 (range 11.7-77.9) months on treatment. Baseline complications were present in all 5 patients (ocular hypertension, glaucoma, cataract, and/or history of cystoid macular edema). In this cohort, two had failed infliximab, four had failed adalimumab, and all five had failed methotrexate monotherapy. Two patients achieved uveitis inactivity and four patients achieved arthritis inactivity while on ABT. Abatacept therapy was discontinued in two patients. Both had uveitis activity requiring >2 drops of prednisolone acetate daily and one had active joint disease. One patient had uveitis control on infliximab and was changed to ABT for arthritis control; uveitis control was maintained on ABT. On average, patients were controlled on ABT by one month and sustained disease inactivity over a 12-month period. No ocular or systemic complications were noted while on ABT.

Conclusions : Abatacept use was associated with control of uveitis in 2 out of 5 patients with active ocular disease at the onset of treatment. Four patients had failed TNF-alpha inhibitors secondary to either persistent joint disease (1) or persistent uveitis (3). Thus, ABT may represent an alternative biologic therapy for a subset of JIA patients with refractory uveitis. However, larger prospective studies are needed to better evaluate the efficacy of the medication.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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