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Sheila T Angeles-Han, Courtney McCracken, Steven Yeh, Kirsten Jenkins, Curtis Travers, Kelly A. Rouster-Stevens, Scott R. Lambert, Carolyn Drews-Botsch, Sampath Prahalad; Methotrexate and tumor necrosis factor- α inhibitors discontinuation in pediatric non-infectious uveitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):408.
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Methotrexate (MTX) and tumor necrosis factor-α inhibitors (TNFi) are treatment for pediatric chronic non-infectious uveitis (NIU). Optimal duration of treatment and factors that lead to sustained remission after medication discontinuation are unclear. Our aim is to describe MTX and TNFi discontinuation in a pediatric NIU cohort.
We reviewed records of 120 children with NIU and identified 28 who tapered and/or discontinued MTX or TNFi.
Sixteen children attempted to discontinue MTX (Table 1) after a median uveitis duration of 2.7 (25th- 75th: 1.9, 3.8) years. Median duration on MTX was 1.6 (1.1 – 2.8) years. Twelve (75%) tapered over a median of 8 months, while 4 (25%) discontinued without taper. Median duration on MTX at taper or discontinuation (in those who did not taper) was 1.6 (1.1, 2.8) years, and at time of discontinuation (after taper or immediately discontinued) was 2.1 (1.4, 3.1) years. Twelve (75%) relapsed and restarted medication at a median of 1 (0.62, 1.76) year.Of the 10 children who discontinued MTX (6 tapered, 4 did not taper), median duration on MTX was 2.1 (1.4, 3.1) years. Six (60%) relapsed and restarted medication at a median of 1.4 (0.7, 2.0) years. Four (25% of total 16) sustained drug-free remission for a median of 0.6 (0.3, 1.8) years.The 12 children on TNFi (10 infliximab, 2 adalimumab) were Caucasian (43%) females (79%), with JIA-associated uveitis (57%). Median duration on TNFi was 1.8 (1.4 - 2.9) years. Most common reason for discontinuation was remission/inactive disease (61%). Of 12, 8 (67%) discontinued without taper. All 8 relapsed and either restarted or switched therapy at a median of 3 months. Four (33%) attempted to taper TNFi. One successfully discontinued, but relapsed after 1.3 years. The other 3 children restarted or switched therapy at a median of 10 months after taper.In MTX, Kaplan-Meier estimates suggest that cumulatively 6.3% relapsed within 3 months, 12.5% within 6 months, 40.2% within 1 year, and 55.1% within 18 months (Fig 1). In TNFi, cumulatively 33% relapsed within 3 months, 50% within 6 months, 83% within 1 year, 92% within 18 months and 100% within 19 months (Fig 1).
Most children were unable to discontinue therapy. Patients on TNFi appear to require medication throughout their disease. Factors leading to successful medication discontinuation and remission in children need further study.
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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