Comparable Efficacy of Abatacept Used as First-line or Second-line Biological Agent for Severe Juvenile Idiopathic Arthritis-related Uveitis

Birolo, Carolina; Zannin, Maria Elisabetta; Arsenyeva, S.; Cimaz, Rolando; Miserocchi, Elisabetta; Dubko, Margarita; Deslandre, Chantal Job; Falcini, Fabio; Alessio, Maria; Torre, Francesco La; Денисова, Е. В.; Martini, Giorgia; Nikishina, Irina; Zulian, Francesco

doi:10.3899/jrheum.151389

Cited by 59 publications

(34 citation statements)

References 23 publications

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“…103 The most recent retrospective case series with 31 patients showed that when abatacept was used as first-line or second-line therapy, >50% of patients had complete remission after 12 months, a comparable result to TNF-α inhibitors. 104 Further studies via well designed prospective randomised controlled trials with larger populations will be required to confirm the findings on these therapies. Table 2 summarises the current recommended dosages, routes of administration, and common adverse events of the biologic agents reviewed in this paper and registered in Australia and New Zealand.…”

Section: Other Targeted Biologic Therapymentioning

confidence: 98%

“…Abatacept has been shown to be a valid alternative to TNF‐α inhibitors for the treatment of severe JIA‐related uveitis . The most recent retrospective case series with 31 patients showed that when abatacept was used as first‐line or second‐line therapy, >50% of patients had complete remission after 12 months, a comparable result to TNF‐α inhibitors …”

Section: Other Targeted Biologic Therapymentioning

confidence: 99%

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The use of biologic agents in the management of uveitis

Trivedi

Katelaris

2019

Internal Medicine Journal

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The uveitides are a heterogenous group of ocular inflammatory disorders that account for the third highest cause of blindness worldwide, responsible for 5–10% of visual impairment globally. Up to 35% of patients with uveitis can suffer significant vision loss. To prevent irreversible structural damage and blindness, it is important that the diagnosis and commencement of appropriate therapy occurs promptly. Management includes topical and systemic corticosteroid therapy and conventional immunomodulatory agents, including methotrexate, azathioprine, mycophenolate mofetil and cyclosporin. Significant progress has been made in the past decade in our understanding of the immunopathological pathways that drive intraocular inflammation, allowing the development of targeted therapy with biologic agents. These include TNF‐α inhibitors, such as infliximab, adalimumab and etanercept; interleukin blockers, such as tocilizumab and daclizumab; and other targeted therapies, such as rituximab and abatacept. The efficacy of these agents has been studied in cases of severe uveitis that are refractory to conventional immunomodulatory agents and provide exciting results that have revolutionised uveitis management. Though the biologic era has provided a large armamentarium to treat uveitis, ongoing challenges and cases of recalcitrant uveitis remain, posing a challenge to internal medicine physicians. This comprehensive review aims to construct an updated summary on the existing evidence pertaining to the use of biologic agents in the treatment of uveitis. Methods include a systematic search for studies between 2000 and 2018 using PubMed, EMBASE, Ovid MEDLINE and Cochrane libraries.

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Section: Other Targeted Biologic Therapymentioning

confidence: 98%

Section: Other Targeted Biologic Therapymentioning

confidence: 99%

The use of biologic agents in the management of uveitis

Trivedi

Katelaris

2019

Internal Medicine Journal

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“…Based on the current literature, recommended alternative nonbiologic options are mycophenolate mofetil (40), leflunomide (41), or cyclosporine (42), and recommended alternative biologic options are abatacept (43)(44)(45) or tocilizumab (46,47); however, evidence supporting preference for a specific nonbiologic or biologic DMARD, combination therapies, and timing of initiation beyond methotrexate, adalimumab, and infliximab is currently lacking. Based on the current literature, recommended alternative nonbiologic options are mycophenolate mofetil (40), leflunomide (41), or cyclosporine (42), and recommended alternative biologic options are abatacept (43)(44)(45) or tocilizumab (46,47); however, evidence supporting preference for a specific nonbiologic or biologic DMARD, combination therapies, and timing of initiation beyond methotrexate, adalimumab, and infliximab is currently lacking.…”

Section: Recommendation 15mentioning

confidence: 99%

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis

Angeles‐Han

Ringold

Beukelman

et al. 2019

Arthritis Care & Research

206

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Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be voluntary, with the ultimate determination regarding their application to be made by the health care provider in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. ACR recommendations are not intended to dictate payment or insurance decisions. These recommendations cannot adequately convey all uncertainties and nuances of patient care.The American College of Rheumatology is an independent, professional, medical and scientific society that does not guarantee, warrant, or endorse any commercial product or service.Objective. To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA).Methods. Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong.Results. Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because ANGELES-HANETAL 704 | of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss.Conclusion. This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE...

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“…Various clinical studies have investigated the use of abatacept for Th1 mediated diseases such as psoriatic arthritis, rheumatoid arthritis and JIA. Furthermore, abatacept has also shown efficacy in patients with uveitis associated with JIA . Several reports have demonstrated the efficacy of abatacept in cases of uveitis refractory to other anti‐TNF agents .…”

Section: Emerging and Adopted Therapiesmentioning

confidence: 99%

“…Furthermore, abatacept has also shown efficacy in patients with uveitis associated with JIA. [207][208][209] Several reports have demonstrated the efficacy of abatacept in cases of uveitis refractory to other anti-TNF agents. [210][211][212] Further larger clinical trials need to be conducted to understand fully the safety and efficacy profile of abatacept.…”

Section: Abataceptmentioning

confidence: 99%

New therapies in development for the management of non‐infectious uveitis: A review

Hassan

Karkhur

Bae

et al. 2019

Clinical Exper Ophthalmology

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Uveitis is a spectrum of inflammatory disorders characterized by ocular inflammation and is one of the leading causes of preventable visual loss. The main aim of the treatment of uveitis is to control the inflammation, prevent recurrences of the disease and preserve vision while minimizing the adverse effects associated with the therapeutic agents. Initial management of uveitis relies heavily on the use of corticosteroids. However, monotherapy with high‐dose corticosteroids is associated with side effects and cannot be maintained long term. Therefore, steroid‐sparing agents are needed to decrease the burden of steroid therapy. Currently, the therapeutic approach for non‐infectious uveitis (NIU) consists of a step‐ladder strategy with the first‐line option being corticosteroids in various formulations followed by the use of first‐, second‐ and third‐line agents in cases with suboptimal steroid response. Unfortunately, the agents currently at our disposal have limitations such as having a narrow therapeutic window along with their own individual potential side‐effect profiles. Therefore, research has been targeted to identify newer drugs as well as new uses for older drugs that target specific pathways in the inflammatory response. Such efforts are made in order to provide targeted and safer therapy with reduced side effects and greater efficacy. Several specially designed molecular antibodies are currently in various phases of investigations that can potentially halt the inflammation in patients with NIU. In the review, we have provided a comprehensive overview of the current and upcoming therapeutic options for patients with NIU.

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Comparable Efficacy of Abatacept Used as First-line or Second-line Biological Agent for Severe Juvenile Idiopathic Arthritis-related Uveitis

Abstract: ABA, used as first-line biological treatment or after 1 or more anti-TNF agents, induces a comparable improvement in severe refractory JIA-related uveitis.

Cited by 59 publications

References 23 publications

The use of biologic agents in the management of uveitis

The use of biologic agents in the management of uveitis

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis

New therapies in development for the management of non‐infectious uveitis: A review

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