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Risk Factors Leading to Anti-TNF Alpha Therapies in Pediatric Severe Uveitis

Delphine Osswald1, Anne-Cécile Rameau2, Joëlle Terzic2

  • 1Service d'Ophtalmologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

Frontiers in Pediatrics
|March 21, 2022
PubMed

Insights

Pediatric uveitis, a leading cause of childhood blindness, necessitates careful management. Identifying risk factors for severe cases can help predict when to initiate anti-tumor necrosis factor alpha (anti-TNFα) therapy, balancing disease control with drug side effects.

Area of Science:

  • Ophthalmology
  • Pediatric Rheumatology
  • Immunology

Background:

  • Pediatric uveitis is a primary cause of acquired childhood blindness, often stemming from persistent inflammation and prolonged corticosteroid use.
  • Biologic therapies, specifically anti-tumor necrosis factor alpha (anti-TNFα) agents, show promise in managing severe pediatric uveitis by controlling inflammation.
  • A critical consideration for anti-TNFα therapy is balancing disease severity against potential drug-related side effects.

Purpose of the Study:

  • To characterize a cohort of children diagnosed with severe uveitis.
  • To identify risk factors associated with a negative disease trajectory requiring anti-TNFα treatment.

Main Methods:

  • A retrospective case-control study was conducted involving children with uveitis linked to systemic inflammatory conditions or idiopathic causes, with a minimum five-year follow-up.
  • Patients treated with anti-TNFα (cases) were compared to those not requiring this therapy (controls).
  • Univariate logistic regression analyses were employed to compare groups and pinpoint risk factors for anti-TNFα initiation.

Main Results:

  • The study included 73 children: 13 treated with anti-TNFα and 60 controls.
  • Significant risk factors for anti-TNFα therapy included: associated systemic disorder (OR=11.22), family history of autoimmune diseases (OR=9.43), uveitis diagnosis before age 6 (OR=4.05), prior eye surgery (OR=26.22), ocular complications at initial exam (OR=67.11), and low visual acuity at diagnosis (OR=11.76 for logMAR, OR=8.75 for binocular acuity).
  • Additional risk factors were panuveitis (OR=9.17), positive antinuclear antibodies (ANA) (OR=3.89), and positive HLA B27 (OR=9.43).

Conclusions:

  • Identified risk factors can inform a refined follow-up and treatment strategy for severe, refractory pediatric uveitis.
  • This approach may improve the prediction of optimal timing for initiating anti-TNFα therapy in pediatric uveitis patients.
Abstract

Keywords:
anti-TNF agentchildrenidiopathic uveitis in childrenjuvenile idiopathic arthritis associated uveitisrisk factorsuveitis (MeSH)

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