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Etanercept therapy in children with treatment-resistant uveitis

A Reiff1, S Takei, S Sadeghi

  • 1Division of Rheumatology, Children's Hospital Los Angeles, California 90027, USA.

Arthritis and Rheumatism
|June 16, 2001
PubMed

Insights

Etanercept, a tumor necrosis factor fusion protein, shows promise in treating pediatric uveitis resistant to other therapies. This study indicates a beneficial effect, warranting further investigation into optimal administration for chronic uveitis.

Area of Science:

  • Ophthalmology
  • Rheumatology
  • Immunology

Background:

  • Uveitis in children, particularly when associated with juvenile rheumatoid arthritis, presents a significant treatment challenge.
  • Previous therapies including topical steroids, methotrexate, and cyclosporine were ineffective in the study cohort.
  • Tumor necrosis factor (TNF) inhibitors are a class of biologic agents used in autoimmune conditions.

Purpose of the Study:

  • To assess the safety and efficacy of etanercept for treating chronic, treatment-resistant uveitis in pediatric patients.
  • To determine the impact of etanercept on ocular inflammation and visual acuity in children.
  • To explore the effectiveness of different dosing regimens of etanercept.

Main Methods:

  • A prospective study involving 10 children (mean age 7.5 years) with chronic active uveitis, many with associated juvenile rheumatoid arthritis.
  • Patients had failed prior treatments with conventional immunosuppressants.
  • Treatment involved subcutaneous etanercept, initially at 0.4 mg/kg twice weekly, with a potential dose increase if needed.

Main Results:

  • Significant reduction in anterior chamber cell density was observed in 63% of affected eyes within 3 months (P = 0.017), with 4 eyes achieving remission.
  • Visual acuity improved in 40% of eyes with pre-existing visual impairment (<20/25).
  • Ocular side effects were minimal, with only one child experiencing uveitis exacerbation; other ocular parameters remained stable.

Conclusions:

  • Subcutaneous etanercept demonstrates a beneficial effect in children with treatment-resistant chronic uveitis.
  • The drug appears safe and effective for this pediatric population.
  • Further controlled studies are needed to confirm efficacy and establish optimal systemic or topical administration routes for etanercept.
Abstract

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