Methotrexate for Uveitis Associated with Juvenile Idiopathic Arthritis: Value and Requirement for Additional Anti-Inflammatory Medication

Heiligenhaus, Arnd; Mingels, A; Heinz, Carsten; Ganser, Gerd

doi:10.1177/112067210701700509

Cited by 102 publications

(53 citation statements)

References 13 publications

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“…Therefore, as monotherapy and in combination with ETA or ADA, MTX seems to have a protective effect on the occurrence of uveitis. Previous open-label studies showed that MTX is an effective treatment for uveitis; approximately 60-70% of patients responded and had a longer remission rate while taking MTX (19,20), and it therefore seems to be protective toward the reoccurrence of uveitis (21).…”

Section: Discussionmentioning

confidence: 99%

Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry

Foeldvari

Becker

Horneff

2015

Arthritis Care & Research

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ObjectiveUveitis is a major extraarticular quality of life–restricting manifestation of juvenile idiopathic arthritis (JIA). The aim of the study is to describe the occurrence of uveitis in JIA patients receiving tumor necrosis factor inhibitors or methotrexate (MTX).MethodsPatients’ characteristics, treatment, and the reported first occurrence of uveitis as an adverse event were searched in the Biologics in Pediatric Rheumatology Registry. The rates per exposed patients, exposure time, and time until event were calculated.ResultsUveitis was reported as an adverse event in 75 of 3,467 patients; 51 of 2,844 patients were receiving MTX, 37 of 1,700 patients were receiving etanercept, and 13 of 364 patients were receiving adalimumab. Patients with uveitis were younger (mean ± SD age 4.6 ± 4.2 versus 7.4 ± 4.5 years; P < 0.0001), more likely to be antinuclear antibody positive (69% versus 43%; odds ratio [OR] 2.7, P < 0.0001), and had extended oligoarticular JIA (OR 2.2, P = 0.0005). Patients with a uveitis diagnosis before starting treatment more often had a uveitis event (n = 28, 8.4%; OR 8.5, P < 0.0001), and more often received adalimumab (OR 2.15 [95% confidence interval 1.58–2.94], P < 0.0001). In 16 patients, a new uveitis event occurred: 11 while taking MTX (3.2 per 1,000 patient‐years), 2 while taking etanercept monotherapy (1.9 per 1,000 patient‐years), and 3 while taking etanercept and MTX combination (0.9 per 1,000 patient‐years). A new uveitis event occurred early in the disease course after a median disease duration of 1.5 years (interquartile range [IQR] 1.3–3.8) while taking etanercept and 1.8 years (IQR 1.8–2.1) for the MTX cohort. A recurrent uveitis event was reported after a disease duration of 7.6 years (IQR 4.3–10.0) in the etanercept cohort and 4.8 years (IQR 1.0–5.8) in the MTX cohort. Univariate analysis showed that MTX, but not etanercept or adalimumab, led to a lower rate of uveitis.ConclusionPatients with a history of uveitis had higher risks for uveitis events while taking both etanercept and adalimumab. Methotrexate turned out to be protective. Few patients developed a first uveitis event while taking etanercept, while the rate is comparable to that with MTX. Uveitis may not be attributed to be an adverse drug reaction to etanercept.

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Section: Discussionmentioning

confidence: 99%

Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry

Foeldvari

Becker

Horneff

2015

Arthritis Care & Research

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“…The positive effect of methotrexate on JIA-associated uveitis has been reported in numerous case series [52][53][54][55][56][57][58][59].…”

Section: Treatment With Immunosuppressives and Biologicalsmentioning

confidence: 98%

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

et al. 2011

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Uveitis in juvenile idiopathic arthritis (JIA) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first-choice therapy, and immunosuppression is commonly used. However, treatment has not been standardized. Representatives from the German Ophthalmological Society, Society for Childhood and Adolescent Rheumatology, and the German Society for Rheumatology reached consensus on a standardized treatment strategy according to disease severity in the individual patient. The recommendations were based on a systematic literature analysis in MEDLINE and consensus expert meetings. Evidence and recommendations were graded, and an algorithm for anti-inflammatory treatment and final statements confirmed in a Delphi method. An interdisciplinary, evidence-based treatment guideline for JIA uveitis is presented.

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“…Nine of them achieved inflammation control on MMF without concomitant corticosteroids or other IMTs for a median of 15 months (range: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. During this follow-up period, 8 out of the 9 patients experienced no uveitis relapse; 1 patient experienced one relapse that was treated with 4 weeks of topical corticosteroids.…”

Section: Treatment Outcomesmentioning

confidence: 99%

Mycophenolate mofetil monotherapy in the management of paediatric uveitis

Chang

Giuliari

Shaikh

et al. 2011

Eye

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Methotrexate for Uveitis Associated with Juvenile Idiopathic Arthritis: Value and Requirement for Additional Anti-Inflammatory Medication

Abstract: The data suggest that MTX is very effective in controlling inflammation of uveitis in patients with JIA. However, additional topical steroids or systemic immunosuppressive drugs are often required.

Cited by 102 publications

References 13 publications

Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry

Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Mycophenolate mofetil monotherapy in the management of paediatric uveitis

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