Related Experiment Video
Updated: Apr 14, 2026
03:37
Intravitreal Injections in the Ovine Eye
Published on: July 5, 2022
4.4K
Uveitis Reactivation in Children Treated With Tumor Necrosis Factor Alpha Inhibitors.
Melissa A Lerman1, Michael D Lewen2, John H Kempen3
1Division of Rheumatology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania.
American Journal of Ophthalmology
|April 21, 2015
Summary
Pediatric uveitis often reactivates after stopping anti-TNFα therapy, with infliximab showing better remission rates than adalimumab. Maintaining treatment longer than 1.5 years did not reduce relapse risk.
Area of Science:
- Ophthalmology
- Rheumatology
- Immunology
Background:
- Pediatric uveitis is a significant cause of vision loss.
- Tumor necrosis factor alpha inhibitors (anti-TNFα) are effective in managing pediatric uveitis.
- Understanding relapse patterns after anti-TNFα treatment is crucial for long-term management.
Purpose of the Study:
- To evaluate the reactivation rates of pediatric uveitis during and after anti-TNFα therapy.
- To identify factors predicting uveitis reactivation in children.
- To compare the long-term outcomes of different anti-TNFα agents.
Main Methods:
- Retrospective cohort study of children (≤18 years) with quiescent uveitis on anti-TNFα.
- Survival analysis to determine reactivation rates on anti-TNFα and after discontinuation.
- Assessment of predictive factors for relapse, including age at onset and specific anti-TNFα agent.
Main Results:
- Approximately 75% of children remained quiescent at 1 year while on anti-TNFα.
- Uveitis reactivation was significantly higher after anti-TNFα discontinuation (63.8%) compared to while on treatment (21.6%).
- Adalimumab use was associated with a higher reactivation risk than infliximab after discontinuation; older age at onset also increased risk.
Conclusions:
- Most children experience uveitis reactivation upon discontinuation of anti-TNFα therapy.
- Infliximab appears to be associated with a higher likelihood of sustained remission off medication compared to adalimumab.
- Extended treatment duration beyond 1.5 years did not appear to decrease the risk of reactivation after discontinuation.
Related Concept Videos
01:01Hypersensitivity Reactions: Cytolytic Reactions
157
Type II hypersensitivity involves IgG and IgM antibodies targeting cell surface antigens, leading to cell destruction. This can occur through complement activation, antibody-dependent cell-mediated cytotoxicity (ADCC), or acting as opsonins for phagocytosis. When excessive, these reactions cause significant tissue damage.Drug-induced hemolytic anemia is a common example, where drugs like penicillin or cephalosporins bind to red blood cells, forming drug-protein complexes. These complexes...
157
01:27Cytomegalovirus Disease
59
Cytomegalovirus (CMV) disease is caused by human cytomegalovirus, a double-stranded DNA virus of the Herpesviridae family. While primary CMV infection is often asymptomatic in immunocompetent individuals, the virus can cause severe disease in neonates and immunocompromised patients. CMV is the most common cause of congenital viral infection in the United States, and a major pathogen in solid organ and hematopoietic stem cell transplant recipients.CMV is transmitted via bodily fluids, sexual...
59
01:14Myocarditis III: Medical Management
329
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
329
01:27Open Angle Glaucoma: Treatment
1.1K
In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
Drugs such as carbonic anhydrase inhibitors, α2- and...
Drugs such as carbonic anhydrase inhibitors, α2- and...
1.1K
01:27Tumor Immunotherapy
2.5K
Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
2.5K
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
804
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
804