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Response of pediatric uveitis to tumor necrosis factor-α inhibitors

Melissa A Lerman1, Jon M Burnham, Peter Y Chang

  • 1Division of Rheumatology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania 19104, USA. lermanm@email.chop.edu

The Journal of Rheumatology
|July 3, 2013
PubMed

Insights

Tumor necrosis factor-α inhibition (anti-TNF) therapy is effective for pediatric uveitis, achieving sustained treatment success in most children. Juvenile idiopathic arthritis-associated anterior uveitis shows particular responsiveness to anti-TNF treatment.

Area of Science:

  • Ophthalmology
  • Rheumatology
  • Immunology

Background:

  • Pediatric uveitis, a chronic inflammatory eye condition, poses a significant risk of vision loss.
  • Noninfectious uveitis in children often requires long-term management with corticosteroids and immunomodulators.
  • Tumor necrosis factor-α (TNF-α) plays a key role in the inflammatory pathways of uveitis.

Purpose of the Study:

  • To evaluate the efficacy and safety of tumor necrosis factor-α inhibition (anti-TNF) therapy in pediatric patients with noninfectious uveitis.
  • To identify factors associated with treatment success in children receiving anti-TNF agents.
  • To assess the rate of sustained remission and adverse events during anti-TNF treatment for pediatric uveitis.

Main Methods:

  • Retrospective analysis of pediatric patients (age ≤ 18 years) with noninfectious uveitis treated with anti-TNF agents across multiple centers.
  • Treatment success defined by minimal or no uveitis activity and reduced corticosteroid dependence.
  • Kaplan-Meier survival analysis and multivariable modeling were used to assess outcomes.

Main Results:

  • The 12-month treatment success rate was estimated at 75% (95% CI 62%-87%), with 64% achieving complete corticosteroid discontinuation.
  • Juvenile idiopathic arthritis (JIA) and anterior uveitis (AU) diagnoses were associated with higher success rates.
  • Compared to JIA-associated AU, other diagnoses had significantly lower rates of achieving quiescence (75%-80% lower).
  • Uveitis recurrence occurred in 14% within 12 months of remission, and discontinuation for adverse effects was infrequent (8%/year).

Conclusions:

  • Anti-TNF therapy is a successful and generally well-tolerated treatment for a majority of children with noninfectious uveitis.
  • Sustained remission is achievable, particularly in patients with JIA-associated anterior uveitis.
  • Anti-TNF agents offer a valuable therapeutic option for pediatric noninfectious uveitis, with a favorable safety profile.
Abstract

Keywords:
JUVENILE IDIOPATHIC ARTHRITISTUMOR NECROSIS FACTOR ANTAGONISTUVEITIS

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