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Published on: September 17, 2014
Efficacy and Safety of Biologics in Pediatric Noninfectious Retinal Vasculitis
Irmak Karaca1, Zheng Xian Thng2, Albert Bromeo3
1From the Spencer Center for Vision Research (I.K., Z.X.T., A.B., A.M., J.-H.H., A.A., N.T.T.T., C.Y., N.Y., D.E.F., O.E., A.N.T.T., X.Z., A.-O.S., F.A.A., Y.B., J.G., C.M.C.O., D.V.D., Q.D.N.), Byers Eye Institute, Stanford University, Palo Alto, California, USA; John A. Moran Eye Center (I.K.), University of Utah, Salt Lake City, Utah, USA.
Purpose:
To assess the efficacy and safety of adalimumab (ADA) injections (group 1), infliximab infusions (IFX) (group 2), and tocilizumab infusions (TCZ) (group 3) in pediatric retinal vasculitis (RV).
Design:
Retrospective interventional case series.
Methods:
Pediatric patients who were diagnosed with RV and treated with biologics (ADA, IFX, TCZ) for ≥6 months were included. A chart review of 11 patients (18 eyes), 17 patients (30 eyes), and 7 patients (11 eyes) in groups 1, 2 and 3, respectively, was performed to assess clinical characteristics, central subfield thickness (CST), and fluorescein angiography (FA) score using the Angiographic Scoring for the Uveitis Working Group (ASUWOG) system.
Results:
Mean age was 13.5 ± 4.3 years in group 1, 11.8 ± 2.5 years in group 2, and 13.9 ± 4.1 years in group 3 (P = .332). Eight patients (72.7%, 13 eyes) in group 1 and 14 patients (82.4%, 24 eyes) in group 2 were biologic naive, whereas in group 3 all patients were treated with ADA and/or IFX prior to TCZ. Mean FA scores were significantly reduced from 6.8 ± 2.6, 13.4 ± 4.8, and 12.8 ± 4.0 at baseline to 0.9 ± 2.3, 3.6 ± 4.6, and 4.4 ± 3.9 at final visit in groups 1, 2, and 3, respectively (P < .05). Complete resolution of RV was observed in 12 (66.7%), 13 (43.3%), and 1 (9.1%) eyes; mean time to complete resolution was 11.0 ± 5.0, 13.3 ± 5.8, and 23 months in groups 1, 2, and 3, respectively. No significant adverse events were observed in any group, except hair loss in 1 patient, which led to discontinuation of IFX infusions after 20 cycles of therapy.
Conclusions:
ADA, IFZ, and TCZ are effective and safe treatment options for pediatric RV, as objectively shown by FA scoring. TCZ appears to be an effective therapy for patients with juvenile idiopathic arthritis-associated RV or those who have failed tumor necrosis factor-α inhibitors.
