Changing biological disease modifying treatment for paediatric uveitis in the real world

Abstract

Purpose : Paediatric uveitis is a severe sight threatening uveitis due to disease progression and treatment failure. Traditionally corticosteroids and immunosuppressive agents are used to treat paediatric uveitis, often with poor outcomes. Biologic agents are a promising new treatment. This retrospective study provides real world data on their use from Sydney, Australia.

Methods : A retrospective, chart review over an 8-year period at a tertiary referral eye hospital of 27 paediatric uveitis patients treated with biologic agents was performed. Demographic data and treatment outcomes evaluating treatment efficacy: corticosteroid-sparing effect, topical steroid cessation/reduction, reduction in systemic-steroid sparing agents, change in intraocular inflammation, visual acuity and central macular thickness and treatment failure: adverse events was analysed. Data was collected at biologic initiation, 6 weeks, 6 months, and 12 months.

Results : Biologic therapy over 1 year was effective with prednisolone dose reduced to <5mg/day in 5 of 6 patients (83%), number ofsystemic steroid-sparing agents was reduced to ≤ 1 in 2/4 patients (50%), and cessation of topical steroid achieved in 12/41 of eyes (29%). Improvement of anterior chamber cells by 2 grades occurredin 20/25 eyes (80%), improvement of logMAR to ≤0.3occurredin 12/18 eyes (67%), and macular oedemadecreasedin 4/5 eyes (80%). Treatment failure occurred in 6 eyes (13.01%) and 5 patients (18.5%) developed an adverse reaction.

Conclusions : Biologic therapy was effective in paediatric patients with uveitis. Intraocular inflammation improved with maintained visual acuity, systemic corticosteroid dose decreased and there was a low frequency of adverse events

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.