The effect of anti-tumor necrosis factor alpha agents on the outcome in pediatric uveitis of diverse etiologies

Deitch, Iris; Amer, Radgonde; Tomkins-Netzer, Oren; Habot‐Wilner, Zohar; Friling, Ronit; Neumann, Ron; Kramer, Michal

doi:10.1007/s00417-018-3928-6

Cited by 30 publications

(27 citation statements)

References 30 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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“…This result is in line with previous studies. Deitch et al [ 17 ] in a study of 43 eyes of 24 patients reported that 82.4% of eyes discontinued using topical steroid eye drops after adalimumab therapy. Castiblanco et al [ 18 ] found that 77% of patients (13/17 eyes) treated with adalimumab achieved steroid-free remission.…”

Section: Discussionmentioning

confidence: 99%

“…Of these six eyes, five relapsed between 3 and 12 months of therapy, but the study did not collect anterior chamber cell data between 3 and 12 months of therapy. Deitch et al [ 17 ] reported that 33.3% of 43 eyes relapsed at 6 months and 4.5% did so at 9 months. Although the recurrence rate differs between studies, adalimumab showed an initial effect with relapse between 3 and 12 months after the start of treatment.…”

Section: Discussionmentioning

confidence: 99%

Quiescence and Subsequent Anterior Chamber Inflammation in Adalimumab-treated Pediatric Noninfectious Uveitis

Choe

Heo

2020

Korean J Ophthalmol

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Purpose To evaluate the effect of adalimumab in pediatric uveitis and subsequent changes in anterior chamber inflammation following the inactivation of uveitis. Methods In this retrospective study, patients with noninfectious uveitis younger than 18 years of age who were treated with adalimumab for more than 12 months were included. The rate of complete suppression and the relapse in anterior chamber inflammation following the initiation of adalimumab therapy were evaluated using anterior chamber cell score and laser flare photometry (LFP) values, if available. Changes in visual acuity and the sparing effect of topical steroid agents were also evaluated. Results Among 22 eyes of 12 pediatric uveitis patients enrolled, 13 eyes were associated with juvenile idiopathic arthritis and nine eyes had idiopathic uveitis. The mean ± standard deviation age was 10.2 ± 3.6 years. Types of uveitis included anterior uveitis (n = 17) and panuveitis (n = 5). Quiescence was observed in 14 eyes (63.6%) at 3 months and in 21 eyes (95.5%) at 12 months after initiation, respectively. After achieving inactive uveitis, uveitis relapsed in two eyes at 6 months, even with adalimumab treatment. In 11 eyes, anterior chamber showed 0.5+ cell scores during the rest of the follow-up period and one of those eyes met the criteria for the relapse based on LFP values. The dosage of topical steroids decreased significantly at 3, 9, and 12 months after the initiation of therapy ( p ≤ 0.05). Visual acuity did not show improvement. There were no severe adverse effects of anti-tumor necrosis factor-α treatment reported. Conclusions In this study, adalimumab achieved a quiescent state in most eyes with pediatric noninfectious uveitis for 12 months with a relapse rate of 9.5%. LFP values together with the anterior chamber cell score can be utilized to monitor the improvement or relapse in anterior chamber inflammation in pediatric noninfectious uveitis.

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“…Importantly, the number of patients with Behçet’s disease is limited in many of the studies based on children. Deitch et al reported the efficacy of adalimumab in 24 children with non-infectious uveitis, only four of which exhibited Behçet’s disease [21]. Ljubetic et al and Biester et al reported the efficacy of adalimumab for refractory childhood uveitis; however, Behçet’s patients were not included [22, 23].…”

Section: Discussionmentioning

confidence: 99%

Early administration of adalimumab for paediatric uveitis due to Behçet’s disease

et al. 2019

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Background Behçet’s disease is a chronic inflammatory multisystem disorder that is characterised by oral and/or genital ulcerations as well as intraocular inflammation. Recurrent retinal vasoocclusive episodes and macular involvement may lead to severe loss of visual acuity. Patients may eventually become resistant to systemic corticosteroid and develop side effects; therefore, other immunosuppressive therapies are needed. Biologic agents are promising for the treatment of Behçet’s disease-associated uveitis. Here, we report two cases of paediatric uveitis due to Behçet’s disease that were successfully treated by early administration of adalimumab. Case presentation Patient 1 was an 11-year-old girl who presented with right conjunctival injection and photophobia. Patient 2 was a 14-year-old girl who presented with blurry vision in the left eye. Both patients were treated with topical treatment and prednisolone for uveitis; however, relapses occurred during the tapering of prednisolone. The patients were diagnosed with Behçet’s disease, and adalimumab therapy was initiated. In both cases, the inflammation was well-controlled by adalimumab administration without local or systemic corticosteroid. Conclusions Adalimumab is effective for treating children with Behçet’s disease-associated uveitis. Control of ocular inflammation was achieved without local and systemic corticosteroid, thus preventing further complications.

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The effect of anti-tumor necrosis factor alpha agents on the outcome in pediatric uveitis of diverse etiologies

Abstract: Treatment of pediatric uveitis with anti-TNF-α agents may improve outcome while providing steroid-sparing effect, when conventional immunosuppression fails. The role of anti-TNF-α agents as first-line treatment should be further investigated in controlled prospective clinical trials.

Cited by 30 publications

References 30 publications

The use of biologic agents in the management of uveitis

The use of biologic agents in the management of uveitis

Quiescence and Subsequent Anterior Chamber Inflammation in Adalimumab-treated Pediatric Noninfectious Uveitis

Early administration of adalimumab for paediatric uveitis due to Behçet’s disease

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