Response of pediatric uveitis to tumor necrosis factor-α inhibitors

Melissa A. Lerman, Jon M. Burnham, Peter Y. Chang, Ebenezer Daniel, C. Stephen Foster, Sean Hennessy, Douglas A. Jabs, Marshall M. Joffe, R. Oktay Kacmaz, Grace A. Levy-Clarke, Monte D. Mills, Robert B. Nussenblatt, James T. Rosenbaum, Eric B. Suhler, Jennifer E. Thorne, John H. Kempen

Research output: Contribution to journalArticle

Abstract

Objective. To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis. Methods. We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses. Results. Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%-87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%-76%). Diagnoses of JIA or AU were associated with greater likelihood of success, as was the oligoarticular subtype among JIA cases. In a multivariable model, compared to those with JIA-associated AU, those with neither or with JIA or AU alone had a 75%-80% lower rate of achieving quiescence under anti-TNF, independent of the number of immunomodulators previously or concomitantly prescribed. Uveitis reactivated within 12 months of achieving quiescence in 14% of those continuing anti-TNF (95% CI 6%-31%). The incidence of discontinuation for adverse effects was 8%/year (95% CI 1%-43%). Conclusion. Treatment with anti-TNF was successful and sustained in a majority of children with noninfectious uveitis, and treatment-limiting toxicity was infrequent. JIA-associated AU may be especially responsive to anti-TNF.

Original languageEnglish (US)
Pages (from-to)1394-1403
Number of pages10
JournalJournal of Rheumatology
Volume40
Issue number8
DOIs
StatePublished - Aug 1 2013

Keywords

  • Juvenile idiopathic arthritis
  • Tumor necrosis factor antagonist
  • Uveitis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

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    Lerman, M. A., Burnham, J. M., Chang, P. Y., Daniel, E., Stephen Foster, C., Hennessy, S., Jabs, D. A., Joffe, M. M., Oktay Kacmaz, R., Levy-Clarke, G. A., Mills, M. D., Nussenblatt, R. B., Rosenbaum, J. T., Suhler, E. B., Thorne, J. E., & Kempen, J. H. (2013). Response of pediatric uveitis to tumor necrosis factor-α inhibitors. Journal of Rheumatology, 40(8), 1394-1403. https://doi.org/10.3899/jrheum.121180