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Treatment outcomes of a Swiss non-infectious paediatric uveitis cohort: retrospective study over ten years
Jeanne Martine Gunzinger1, Seraina Palmer Sarott2, Fabio Meier3
1Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, Zurich, 8091, Switzerland. Jeanne.gunzinger@gmail.com.
Insights
This study evaluated the step-up treatment for pediatric uveitis, finding it safe for visual acuity. However, methotrexate showed high failure and adverse effects, while biologics like adalimumab were effective.
Area of Science:
- Ophthalmology
- Pediatric Rheumatology
- Immunology
Background:
- Current pediatric uveitis guidelines recommend a step-up treatment strategy, starting with topical therapies and progressing to systemic agents like antimetabolites and biologics.
- This study investigates the safety and effectiveness of this established treatment paradigm in a large cohort of pediatric patients.
Purpose of the Study:
- To assess the safety and efficacy of the step-up treatment approach for non-infectious pediatric uveitis.
- To evaluate visual acuity outcomes, treatment response, and adverse events associated with different treatment escalation levels.
Main Methods:
- A single-center retrospective study included 64 pediatric patients (under 18) with non-infectious uveitis diagnosed between 2012 and 2022.
- Data on demographics, uveitis characteristics, treatments (topical, methotrexate, TNF alpha inhibitors), visual acuity, and complications were extracted from electronic health records.
- Patients were categorized by their final treatment regimen, and outcomes were analyzed.
Main Results:
- Topical treatment led to remission in 23% of cases, antimetabolites in 12%, and TNF alpha inhibitors in 30%.
- Significant delays were observed in initiating antimetabolite (115 days) and TNF alpha inhibitor (269 days) therapies.
- Visual acuity outcomes did not significantly differ across treatment groups, but consultation frequency increased with treatment escalation.
Conclusions:
- The step-up treatment approach for pediatric uveitis is safe concerning visual acuity outcomes.
- Methotrexate demonstrated a high rate of treatment failure and adverse effects, whereas adalimumab and infliximab proved effective and safe.
- Prompt treatment escalation may reduce the overall burden of care for children, families, and healthcare providers.
Introduction:
Paediatric uveitis treatment recommendations suggest a step-up treatment approach starting with topical treatment, followed by antimetabolites and thereafter biologics. With this study, we are investigating the safety and efficacy of the current treatment approach in a large cohort.
Material And Methods:
Single center retrospective study. Patients with non-infectious uveitis under the age of 18 years at first presentation, between January 2012 and June 2022, were eligible for inclusion. Data extracted from the electronic health records included age at first presentation, sex, involved eye segment, visual acuity (VA), complications, associated systemic disease, treatments, and number of consultations. Cases were grouped according to their final treatment regime (topical only, methotrexate, TNF alpha inhibitor, other). VA outcome, treatment response, adverse events, and frequency of consultations were evaluated. The study was approved by the local ethics committee.
Results:
64 non-infectious paediatric uveitis cases were included. Age at first diagnosis ranged from 2 to 17 years, with a two-peak distribution, 52% were male. Anterior uveitis was the most common presentation, followed by intermediate uveitis, posterior uveitis, and panuveitis. Topical treatment achieved remission in 23%, anti-metabolites in 12%, and escalation to TNF alpha inhibitors in 30%. Alternative treatments or observation only were documented in 16% and 17%, respectively. Median duration from first presentation to the start of anti-metabolite or TNF alpha inhibitor were 115 days and 269 days, respectively. There was a median of eight consultations during the first year of follow up. Frequency of consultations during the first year increased with every treatment escalation. VA outcome did not differ between the different treatment groups.
Conclusion:
The step-up treatment approach shows a safe profile in regards to VA outcome. Methotrexate presents a high rate of treatment failure and adverse effects. Adalimumab and infliximab are effective and safe. Timely treatment escalation might lower treatment burden for affected children, their families, and health care providers.
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