June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Treatment of Children with Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to Methotrexate, Adalimumab and Infliximab
Author Affiliations & Notes
  • Sheila T Angeles-Han
    Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
    Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States
  • Theresa Hennard
    Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Joseph McDonald
    Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Amy Cassedy
    Biostatistics, Cincinnati Children's Hospital Medical Center, Ohio, United States
  • Najima Mwase
    Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Footnotes
    Commercial Relationships   Sheila Angeles-Han, None; Theresa Hennard, None; Joseph McDonald, None; Amy Cassedy, None; Najima Mwase, None
  • Footnotes
    Support  NIH Grant K23EY021760
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 5360. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Sheila T Angeles-Han, Theresa Hennard, Joseph McDonald, Amy Cassedy, Najima Mwase; Treatment of Children with Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to Methotrexate, Adalimumab and Infliximab. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5360.

      Download citation file:


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

      ×
  • Supplements
Abstract

Purpose : Juvenile idiopathic arthritis-associated uveitis (JIA-U) can lead to sight-threatening ocular complications. Typical treatment includes topical glucocorticoids followed by methotrexate (MTX) and the TNF-α inhibitors (TNFi) adalimumab (ADA) and infliximab (IFX). Data is limited on the optimal agent for children refractory to MTX and traditional TNFi (tTNFi). Our aim is to describe medication use for refractory JIA-U following MTX and tTNFi failure.

Methods : We reviewed records of 52 JIA-U children enrolled in a prospective JIA/uveitis study who were treated with MTX and/or tTNFi (ADA or IFX) for: 1) uveitis only, or 2) uveitis and arthritis. We collected data on those who failed treatment with a tTNFi (anterior chamber (AC) cells ≥0.5+ for >3 months after MTX and/or tTNFi) and required another biologic beyond tTNFi.

Results : Of 52 JIA-U children, 16 (31%) remained on MTX monotherapy, 25 (48%) required addition of tTNFi (2 tTNFi only, 23 TNFi with MTX), and 11 (21%) escalated to a biologic beyond tTNFi (Table 1).
Of 11 children requiring a biologic beyond tTNFi, 5 (45%) were treated with tocilizumab (TCZ), 4 (36%) golimumab (GOL), and 2 (18%) abatacept (ABA) (Table 2). Four children (36%) decreased prednisolone acetate to ≤2 drops/day, and 6 (54%) discontinued. Children diagnosed with JIA at a younger mean [SD] age (2.5 [1.2] vs. 4.4 [3.4], p=0.018) were more likely to fail tTNFi. There was a similar clinical trend in females (100 vs. 72%), those with bilateral disease (91 vs. 60%) and cataracts (55 vs. 24%). Of these 11, 2 failed initial treatment with ABA and TCZ and required another biologic for uveitis.

Conclusions : 21% of JIA-U children in our cohort failed treatment with MTX and tTNFi. Our results suggest that ABA, TCZ and GOL are potential therapeutic options. JIA diagnosis at a young age may be associated with tTNFi failure. Further study is needed on factors that may be associated with failure of MTX and tTNFi such as sex and ocular complications, and on optimal treatment of children JIA-U refractory to tTNFi.

This is a 2020 ARVO Annual Meeting abstract.

 

 

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×