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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
PubMed

Insights

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.
Abstract

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