The effect of anti-TNF α therapy on refractory non-infectious pediatric uveitis in Saudi Arabia

PURPOSE: To report the outcomes of anti-tumor necrosis factor alpha (anti-TNF-α) treatment in children with refractory non-infectious uveitis. METHODS: Retrospective chart review for all children aged ≤ 18 years, diagnosed to have non-infectious uveitis, treated with anti-TNF-α medications (Infliximab or Adalimumab) from Jan 2014 to Dec 2021 with at least 1-year follow-up after initiation of treatment at King Khaled Eye Specialists Hospital (KKESH). RESULTS: A total of 32 patients (61 eyes) were included in the study. Thirteen patients (40.6%) were males, and 19 patients (59.4%) were females. The mean age upon presentation was 9.8 ± 3.9 years. The mean duration of follow-ups was 7.6 ± 2.2 years. Persistent anterior uveitis activity was noted in 58 eyes (95.1%), uveitic macular edema in 5 eyes (8.2%), vitritis in 7 eyes (11.5%), and vasculitis in 4 eyes (6.6%). Thirty patients (93.8%) were prescribed adalimumab, and 2 patients (6.2%) were prescribed infliximab. The addition of anti-TNF-α has significantly improved anterior uveitis activity (P < 0.001), the grade of anterior uveitis (P < 0.001), vitritis (P = 0.007), the grade of vitritis (P = 0.017), and disc edema (P = 0.014). Over 5 years of follow-ups, oral prednisolone doses were significantly reduced from 10.4 ± 4.3 mg in 25 children to full steroids sparing treatments (P < 0.001). There were no cataracts developed after the initiation of anti-TNF-α over 5 years of follow-up, while 2 eyes developed uveitic glaucoma. CONCLUSION: The addition of anti-TNF-α achieves better uveitis control in pediatric patients who are not well controlled on conventional immunosuppressive treatment. Timely addition of anti-TNF-α leads to a lower incidence of long-term complications.