June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Alternative therapy in pediatric chronic anterior uveitis refractory to methotrexate, adalimumab and infliximab
Author Affiliations & Notes
  • Sheila T Angeles-Han
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
    Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Virginia Miraldi Utz
    Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Najima Mwase
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Amy Cassedy
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Theresa Hennard
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Hermine Brunner
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Eniolami Dosunmu
    Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Alexei Grom
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Michael Henrickson
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Jennifer Huggins
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Sarah Lopper
    Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Daniel Lovell
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Robert Sisk
    Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Tracy Ting
    Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Adam Kaufman
    Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Footnotes
    Commercial Relationships   Sheila Angeles-Han None; Virginia Utz None; Najima Mwase None; Amy Cassedy None; Theresa Hennard None; Hermine Brunner AstraZeneca, Boehringer Ingelheim, GSK, Roche, Novartis, Pfizer Inc, Takeda, and UBC, Code C (Consultant/Contractor), Cincinnati Children’s Hospital Medical Center has received research grants from BMS, Janssen, Novartis, Pfizer Inc, Roche, and UBC, Code F (Financial Support), DSMB member for Janssen Pharmaceutical’s trial of ustekinumab pediatric Crohn and Ulcerative colitis, Code S (non-remunerative); Eniolami Dosunmu None; Alexei Grom None; Michael Henrickson None; Jennifer Huggins None; Sarah Lopper None; Daniel Lovell consulting fees or other remuneration from AstraZeneca, Boehringer Ingelheim, GSK, Roche, Novartis, Pfizer Inc, Takeda, and UBC, Code C (Consultant/Contractor), Cincinnati Children’s Hospital Medical Center has received research grants from BMS, Janssen, Novartis, Pfizer Inc, Roche, and UBC, Code F (Financial Support), DSMB member for the Canadian Arthritis Foundation and the NIH-NIAMS, Code S (non-remunerative); Robert Sisk AGTC, Gyroscope, and Leica, Code C (Consultant/Contractor); Tracy Ting None; Adam Kaufman Alcon, Bausch & Lomb, and 1800contacts, Code C (Consultant/Contractor)
  • Footnotes
    Support  NEI K23EY021760 and R01EY030521
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3189 – A0415. doi:
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      Sheila T Angeles-Han, Virginia Miraldi Utz, Najima Mwase, Amy Cassedy, Theresa Hennard, Hermine Brunner, Eniolami Dosunmu, Alexei Grom, Michael Henrickson, Jennifer Huggins, Sarah Lopper, Daniel Lovell, Robert Sisk, Tracy Ting, Adam Kaufman; Alternative therapy in pediatric chronic anterior uveitis refractory to methotrexate, adalimumab and infliximab. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3189 – A0415.

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

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Abstract

Purpose : More than 50% of children with chronic anterior uveitis (CAU) fail standard methotrexate (MTX) and conventional tumor necrosis factor α inhibitors (cTNFi) therapy. Data are lacking on optimal next therapy. Our aim is to compare the characteristics of children treated with MTX, cTNFi, and alternative biologic agents (ABT) for CAU.

Methods : We reviewed records of 52 children. We grouped based on therapy required to control CAU for ≥3 months. CAU control was defined by all: 1) inactive per SUN criteria, 2) no vitreous haze or uveitis activity by dilated exam or imaging, 3) ≤2 drops of prednisolone acetate 1% or equivalent/day, and 4) no oral corticosteroid.

Results : Of 52 children, CAU was controlled by MTX monotherapy in 15/52, cTNFi in 28/52, and ABT in 9/52 (abatacept-1, tocilizumab-3, and/or golimumab-5). All patients requiring ABT were ANA positive compared to MTX (67%) and cTNFi (71%) groups but not significantly different (NS) (Table 1).
Comparing 28 children controlled on adalimumab (ADA) to 9 who escalated to ABT, the ADA dose, non-biologic DMARD use, and treatment duration were similar. Neutralizing anti-ADA antibodies occurred in 1 patient on ADA compared to 4 on ABT (p<0.005).
Comparing 36 children controlled on infliximab (IFX) to 3 who escalated to ABT, IFX was given every 4 weeks at 10 mg/kg/dose (IQR 9.6-11.5) in those on cTNFi, and 7.5 mg/kg/dose (IQR 5-10) on ABT (NS). Infusion reactions occurred in 2 of 3 escalating to ABT. Human anti-chimeric antibodies occurred in 2 patients on ABT compared to 0 on cTNFi despite MTX (NS).
Ocular complications at presentation were similar among all groups. Those on MTX were less likely to develop synechiae, cataracts, ocular hypertension and glaucoma compared to those on cTNFi or ABT (Table 2). Total ocular complication rate (3.4 per person) was higher in those on ABT compared to MTX (0.7 per person) (p<0.001) and cTNFi (1.5 per person) (p<0.001). Patients on ABT were more likely to have used intraocular pressure-reducing agents prior to ABT compared to cTNFi (p=0.011).

Conclusions : Abatacept, golimumab, and tocilizumab may be useful in CAU children who fail MTX and cTNFi. Patients that required ABT had more complications, and anti-cTNFi neutralizing antibodies. The higher incidence of complications may reflect prolonged duration of poor CAU control prior to initiation of ABT.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

 

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