Abatacept in biologic-refractory juvenile idiopathic arthritis-associated uveitis: a case-based review

Monoclonal anti-tumor necrosis factor (anti-TNF) agents have substantially improved the management of juvenile idiopathic arthritis (JIA)-associated uveitis. However, some patients remain refractory despite multiple biologic therapies. We aimed to evaluate the outcomes of abatacept in patients with chronic JIA-associated uveitis refractory to synthetic DMARDs, anti-TNF agents, and tocilizumab at a tertiary referral center and to review the available pediatric literature.

This retrospective observational series included patients with chronic JIA-associated uveitis treated with abatacept after inadequate response to anti-TNF agents and tocilizumab. Ocular outcomes included achievement of inactive uveitis, discontinuation of topical corticosteroid therapy, and adverse events. Articular disease activity and additional treatments required during abatacept therapy were also recorded. A systematic review of the pediatric literature on abatacept treatment for JIA-associated uveitis was additionally performed.

Seven patients were included. By month 3, five patients achieved inactive uveitis and discontinued topical corticosteroid therapy, whereas two patients showed no ocular response. Among the five responders, one discontinued abatacept at month 9 because of a skin infection requiring hospitalization and intravenous antibiotics, while the remaining four maintained inactive uveitis through month 12. Articular responses were less consistent, and four patients required additional treatment for arthritis during follow-up. The literature review identified 15 studies including 95 abatacept-treated patients, with reported remission rates ranging from 0 to 100%.

Abatacept may be a useful therapeutic option for JIA-associated uveitis refractory to anti-TNF agents and tocilizumab. Ocular response may occur despite persistent or recurrent articular activity, suggesting that ocular and articular outcomes should be assessed separately. Larger prospective studies are needed to better define the role of abatacept in refractory JIA-associated uveitis.