Clinical trials in pediatric uveitis

Abstract

Uveitis associated with juvenile rheumatoid arthritis is the most common form of ocular inflammation in children. Prevention of permanent visual damage by this silent disease requires heightened awareness from pediatric rheumatologists and ophthalmologists. Early prediction of severity and prognosis will aid in the identification of those patients requiring more aggressive management. Generally, reports using immunosuppressives in this population are small, uncontrolled, and retrospective. Large-scale collaborative studies have been proposed and are underway. Hopefully, collaborations between pediatricians, pediatric rheumatologists, and ophthalmologists will allow the development of straightforward treatment guidelines for children suffering from chronic uveitis and its related complications.

Current evidence of methotrexate efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach

“…There are no clear recommendations for MTX use in childhood, even though it is largely used in chronic uveitis, mostly when associated with JIA [2,3,1620]. The results of this review could be helpful for clinicians in judging the utility of this treatment and its effect size on visual prognosis, as well in making a therapeutic decision based on current available evidence.…”

“…In case of refractory uveitis, early and aggressive immune-modulatory treatment, even in children, seems a reasonable approach to control inflammation, to achieve a CS-sparing effect and to decrease the risk of sight-threatening ocular damage [1]. However, there is much less experience and fewer cumulative data in treating children with uveitis or other inflammatory ocular diseases [2], and a lack of randomized controlled trials (RCTs) means that treatment with immunosuppressive drugs is supported only at evidence level III: expert opinion, clinical experience or descriptive studies [3]. MTX, a folate analogue inhibiting the enzyme dihydrofolate reductase, is the most frequently used immunosuppressive in the paediatric uveitis population, but the lack of evidence from RCTs limits our understanding of effectiveness, the optimal time to start therapy and optimal duration [2,3].…”

“…However, there is much less experience and fewer cumulative data in treating children with uveitis or other inflammatory ocular diseases [2], and a lack of randomized controlled trials (RCTs) means that treatment with immunosuppressive drugs is supported only at evidence level III: expert opinion, clinical experience or descriptive studies [3]. MTX, a folate analogue inhibiting the enzyme dihydrofolate reductase, is the most frequently used immunosuppressive in the paediatric uveitis population, but the lack of evidence from RCTs limits our understanding of effectiveness, the optimal time to start therapy and optimal duration [2,3]. Due to its common use as steroid-sparing treatment in children, the purpose of this review is to summarize the best available evidence to date regarding the effectiveness of MTX in childhood autoimmune chronic uveitis (ACU).…”