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Alternative Biologic Therapy in Children Failing Conventional TNFα Inhibitors for Refractory, Noninfectious, Chronic

Virginia Miraldi Utz1, Sheila T Angeles-Han2, Najima Mwase3

  • 1From the Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center (V.M.U., S.T.A.-H., S.L., E.O.D., R.A.S., A.H.K.).

American Journal of Ophthalmology
|July 21, 2022
PubMed

Insights

Alternative biologic treatments effectively controlled chronic anterior uveitis in children who did not respond to conventional therapies. These treatments were successful even in patients with more severe disease and prior complications.

Area of Science:

  • Ophthalmology
  • Pediatric Rheumatology
  • Immunology

Background:

  • Noninfectious chronic anterior uveitis (CAU) in children often requires advanced treatment strategies.
  • Conventional therapies, including methotrexate (MTX) and TNFα inhibitors (cTNFi), are not always effective.
  • Alternative biologic treatments (ABT) offer a potential solution for refractory cases.

Purpose of the Study:

  • To review the clinical and treatment characteristics of pediatric CAU patients requiring ABT.
  • To evaluate the efficacy of ABT in children with noninfectious CAU refractory to conventional therapy.

Main Methods:

  • Retrospective, nonrandomized clinical study at a tertiary center.
  • Compared clinical characteristics, uveitis course, complications, and treatment outcomes.
  • Analyzed patients treated with MTX monotherapy, cTNFi, and ABT (abatacept, tocilizumab, golimumab) for over 3 months.

Main Results:

  • Of 52 children with CAU, 75% had juvenile idiopathic arthritis.
  • CAU was controlled in 9 children receiving ABT, with successful tapering of topical glucocorticoids.
  • Patients on ABT had more prior ocular complications and anti-cTNFi neutralizing antibodies compared to control groups.

Conclusions:

  • Alternative biologics (abatacept, golimumab, tocilizumab) are effective for pediatric CAU refractory to MTX and cTNFi.
  • Patients requiring ABT often present with higher disease activity and prior complications.
  • Further research with larger cohorts is needed to validate these findings.
Abstract

Keywords:
Pediatric uveitisanti-biologic antibodiesbiologicchildhood uveitischronic anterior uveitistreatmenttreatment outcomes

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