Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis

Cecchin, Vanessa; Zannin, Maria Elisabetta; Ferrari, Daniele; Pontikaki, Irene; Miserocchi, Elisabetta; Paroli, Maria Pia; Bracaglia, Claudia; Marafon, Denise Pires; Pastore, Serena; Parentin, Fulvio; Simonini, Gabriele; Libero, Cinzia de; Falcini, Fabio; Petaccia, Antonella; Filocamo, G; Marco, Riccardo De; Torre, Francesco La; Guerriero, Silvana; Martino, Silvana; Comacchio, Francesco; Muratore, Valentina; Martini, Giorgia; Vittadello, Fabio; Zulian, Francesco

doi:10.3899/jrheum.171006

Cited by 63 publications

(40 citation statements)

References 14 publications

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“…77 Adalimumab was also shown to be better tolerated, with six patients in the study switching from infliximab to adalimumab due to infusion reactions or difficulty complying with infliximab. Recent studies with long-term follow up also conclude that adalimumab showed a superior efficacy and safety profile than infliximab, 78,79 and these results coincide with previous comparative studies between the two agents. 80,81 In contrast to these studies, two large retrospective studies showed that efficacy is similar and sustained regardless of the TNF-α inhibitor used, with no statistically significant difference in the response rates between infliximab and adalimumab.…”

Section: Comparative Studies Between Tnf-α Inhibitorssupporting

confidence: 85%

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: Comparative Studies Between Tnf-α Inhibitorssupporting

confidence: 85%

The use of biologic agents in the management of uveitis

Trivedi

Katelaris

2019

Internal Medicine Journal

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“…3 TNF-α inhibitors showed to be effective in different forms of (childhood) uveitis. [4][5][6][7][8] They are, however, being given with caution in case of traditional IMT failure because of reports on demyelination in patients with non-anterior uveitis. Therefore, in all patients with non-anterior uveitis, an MRI scan of the brain is recommended before starting TNF-α inhibitors.…”

Section: Discussionmentioning

confidence: 99%

“…Baseline n = 7 6 months n = 7 P-value b 12 months n = 6 P-value b FA CME a 3 (1-4) 0 (0-1) .017 0.5 (0-1.25) .027 FA capillary leakage a 7.0 (6-10) 4.0 (0-7) .017 2.5 (0.75-4.25) .028 FA vasculitis a 2 (1-3) 1 (0-2) .034 0 (0-0.5) .056 FA optic disc leakage a 2 (0-3) 1 (0-2) .034 1 (0-2) .083 FA total score a 14 (10)(11)(12)(13)(14)(15)(16)(17)(18) 8 (2)(3)(4)(5)(6)(7)(8)(9) .018 5 (1. Data given as median (interquartile range).…”

Section: Discussionmentioning

confidence: 99%

“…3 The therapeutic potential of adalimumab (TNF-α inhibitor) in adults with noninfectious uveitis and children with juvenile idiopathic arthritis (JIA) associated uveitis is well known. [4][5][6][7][8] However, caution should be kept in mind for TNF-α inhibitors as a treatment for intermediate uveitis (IU) due to a potentially increased risk of demyelinating disease of the central nerve system. 6 So there is an unmet need for additional effective treatment options in children with refractory IU and panuveitis dependent on chronic treatment with corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

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Tocilizumab as an Effective Treatment Option in Children with Refractory Intermediate and Panuveitis

Wennink

Ayuso

Vries

et al. 2020

Ocular Immunology and Inflammation

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Purpose: To describe the results of tocilizumab treatment in children with refractory non-anterior uveitis. Methods: A case series of seven children with refractory non-anterior uveitis (onset ≤16 years) with leakage on fluorescein angiogram (FA) were treated with tocilizumab intravenously every 4 weeks (eight mg/kg). Minimum follow-up was 6 months. Reported outcomes are changes in BCVA, central macular thickness (CMT) on OCT image, FA scores, dose of systemic steroids, complications and side effects. Results: In all patients, there was an improvement of macular edema and capillary leakage on FA. The median FA score decreased from 14 (10-18) at baseline to 8 (2-9) after 6 months of treatment (p = .018). The CMT decreased from 321 (314-384) to 295 (255-312) (p = .043). BCVA improved in five eyes and worsened in one eye due to cataract. No systemic or ocular complications were reported. Conclusion: Tocilizumab is an effective therapeutic option for reducing disease activity in children with refractory non-anterior uveitis.

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“…DMARDs, methotrexate being the most commonly employed, should be initiated in patients unresponsive to corticosteroids and it is recommended that early initiation of immunosuppressive treatment should be considered in children with active uveitis with already established complications at the time of diagnosis. 4,[24][25][26] Complications of pediatric uveitis are band keratopathy, cataracts, synechia, glaucoma, cystoid macular edema, retinal detachment, neovascularization of retina, optic disc and iris, decreased visual acuity, and loss of vision. These complications have been reported to be seen in more than half of the patients.…”

Section: Discussionmentioning

confidence: 99%

Etiologic Spectrum and Follow-Up Results of Noninfectious Uveitis in Children: A Single Referral Center Experience

et al. 2019

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Objectives: This study aims to investigate the etiologic spectrum, demographic features, and long-term follow-up results of children with noninfectious uveitis (NIU). Patients and methods: Files of patients with NIU were reviewed between May 2010 and September 2017. The cohort consisted of 54 juvenile uveitis patients (26 males, 28 females; mean age 7.7 years; interquartile range [IQR] 9.2 years) with 93 affected eyes. Location of uveitis, laterality, age at onset of uveitis, complications of uveitis, duration of follow-up, associated systemic diseases, pertinent laboratory tests, medications used, and status of uveitis at the time of enrollment were recorded from the files. All patients had final systemic and ocular examination at the last month of enrollment. Results: Twenty-seven patients (50.0%) had juvenile idiopathic arthritis (JIA), 17 (31.4%) had idiopathic uveitis, six (11.1%) had Behçet disease (BD), and four (7.5%) had tubulointerstitial nephritis and uveitis (TINU) syndrome. Median duration of follow-up for uveitis was 16 (IQR: 15) months. Anterior uveitis was seen in 81.4% of the patients (65.9% had bilateral and 34.1% had unilateral anterior uveitis). Bilateral intermediate uveitis was observed in 11.2% and bilateral panuveitis in 7.4% of the patients. At the time of enrollment, 45 uveitis patients (83.3%) were under remission. Complications of uveitis were observed in 18.5% of the patients. Conclusion: Patients with JIA and BD should be regularly checked for uveitis. It is challenging to find an etiology in uveitis patients referred from ophthalmologists if initial questioning and examination do not reveal an overt rheumatologic disease. However, a simple urine test may help in establishing the diagnosis of TINU syndrome.

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Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis

Cited by 63 publications

References 14 publications

The use of biologic agents in the management of uveitis

The use of biologic agents in the management of uveitis

Tocilizumab as an Effective Treatment Option in Children with Refractory Intermediate and Panuveitis

Etiologic Spectrum and Follow-Up Results of Noninfectious Uveitis in Children: A Single Referral Center Experience

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