Tocilizumab for Severe Chronic Anterior Uveitis Associated with Juvenile Idiopathic Arthritis in a Pediatric Patient

Tsang, Adrian; Roth, Johannes; Gottlieb, Chloe

doi:10.3109/09273948.2013.866254

Cited by 46 publications

(17 citation statements)

References 8 publications

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“…However, our strategy research was able to identify 5 additional children, who experienced sustained improvement of uveitis after the specific NTT treatment, thus supporting our results: 2 children, 1 boy with Blau syndrome [24] and 1 with juvenile Behçet's disease [25], received canakinumab; 1 girl with JIA received abatacept [26]; and 1 boy with CINCA syndrome anakinra [27] and another 1 with JIA received tocilizumab [28]. With regard to adults, rituximab has been reported to maintain remission in a patient with Behçet's disease retinal vasculitis and related posterior uveitis [29] and in a 40-year-old male suffering from anterior uveitis secondary to type II essential cryoglobulinemia [30] at 24-and 6-month follow-up, respectively.…”

Section: Discussionsupporting

confidence: 84%

Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: The current evidence from a systematic review

Simonini

Cimaz

Jones

et al. 2015

Seminars in Arthritis and Rheumatism

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Section: Discussionsupporting

confidence: 84%

Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: The current evidence from a systematic review

Simonini

Cimaz

Jones

et al. 2015

Seminars in Arthritis and Rheumatism

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“…Two case reports have described its benefit in maintaining quiescence in a total of four patients with recalcitrant JIA-U. Each had persistent activity despite CS, conventional immunosuppressants and TNF inhibitors (one had also failed abatacept and rituximab) (113,114). A clinical trial is currently underway to examine its utility.…”

Section: Blockade Of Other Pro-inflammatory Cytokinesmentioning

confidence: 99%

The Future Is Now: Biologics for Non-Infectious Pediatric Anterior Uveitis

Lerman

Rabinovich

2015

Pediatr Drugs

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Anterior uveitis (AU), inflammation of the iris, choroid, or ciliary body, can cause significant eye morbidity, including visual loss. In the pediatric age group, the most common underlying diagnosis for AU is juvenile idiopathic associated uveitis and idiopathic AU, which are the focus of this paper. AU is often resistant to medications such as topical corticosteroids and methotrexate. In the past 15 years, biologic agents (biologics) have transformed treatment. In this review, we discuss those in widespread use and those with more theoretical applications for anterior uveitis. Tumor Necrosis Factor alpha inhibitors (anti-TNFα) have been available the longest and are used widely to treat pediatric uveitis. The effects of anti-TNFα in children are described mostly in small retrospective case series. Together, the literature suggests that the majority of children treated with anti-TNFα achieve decreased uveitis activity and reduce corticosteroid burden. However, many will have disease flares even on treatment. Only a few small studies directly compare outcomes between alternate anti-TNFα (infliximab and adalimumab). The use of different uveitis grading systems, inclusion criteria, and outcome measures, makes cross-study comparisons difficult. Whether the achievement and maintenance of inactive disease occurs more frequently with certain anti-TNFα remains controversial. Newer biologics that modulate the immune system differently (e.g., interfere with TH17 activation through IL-17a and IL-6 blockade, limit T lymphocyte costimulation, and deplete B lymphocytes), have shown promise for uveitis. Studies of these agents are small and include mostly adults. Additional biologics are also being explored to treat uveitis. With their advent, we are hopeful that outcomes will ultimately be improved for children with AU. With many biologics available, much work remains to identify the optimal inflammatory pathway to target in AU.

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“…We would emphasize that the lack of disease specificity of other soluble mediators in this study does not mean that they do not play a significant role in its pathophysiology. Therapy with anti‐TNF (adalimumab) and anti–IL‐6 (tocilizumab), for example, has been shown to effectively control uveitis in some JIA patients . Nevertheless, in a significant proportion of children with JIA‐associated uveitis, most conventional treatments are either inadequate or frequently accompanied by severe adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Ocular Fluid Analysis in Children Reveals Interleukin‐29/Interferon‐λ1 as a Biomarker for Juvenile Idiopathic Arthritis–Associated Uveitis

Haasnoot

Kuiper

Hiddingh

et al. 2016

Arthritis & Rheumatology

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Objective. Childhood uveitis is a vision-threatening inflammatory eye disease commonly attributed to juvenile idiopathic arthritis (JIA). The pathogenesis is poorly understood, which makes clinical management challenging. We analyzed soluble mediators in ocular fluid (aqueous humor [AqH]) and serum from children with JIAassociated uveitis and common childhood uveitis to identify potential biomarkers and investigate the ocular microenvironment of this sight-threatening eye disease.Methods. AqH (n 5 73) and paired serum (n 5 66) samples were analyzed for 51 soluble mediators of inflammation by multiplex immunoassay. Twenty-one children with JIA-associated uveitis were compared to 15 children with chronic anterior uveitis without arthritis, 29 children with noninfectious idiopathic uveitis, and 8 children with noninflammatory conditions (controls). For visualization of the joint effect of multiple mediators, we used the radial coordinate visualization (Radviz) method. Optimal biomarker level cutoffs were also determined.Results. The levels of interleukin-29 (IL-29)/ interferon-l1 (IFNl1) were decreased (P < 0.001) and the levels of latency-associated peptide and osteoprotegerin were increased (P 5 0.002 and P 5 0.001, respectively) in samples of AqH, but not serum, from patients with JIA-associated uveitis. Multivariate analysis correcting for disease activity and treatment revealed that intraocular levels of IL-29/IFNl1 were specifically decreased in patients with JIA-associated uveitis as compared to those with idiopathic uveitis. Indeed, JIAassociated uveitis patients and idiopathic uveitis patients showed distinct profiles of intraocular soluble mediators. IL-29/IFNl1 showed a high area under the curve value (0.954), with 23.5 pg/ml as the optimal cutoff value.Conclusion. We identified IL-29/IFNl1 as an intraocular biomarker for JIA-associated uveitis, which suggests that aberrant IFNl signaling might be important in JIA-associated uveitis and distinct from other forms of childhood uveitis.

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Tocilizumab for Severe Chronic Anterior Uveitis Associated with Juvenile Idiopathic Arthritis in a Pediatric Patient

Cited by 46 publications

References 8 publications

Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: The current evidence from a systematic review

Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: The current evidence from a systematic review

The Future Is Now: Biologics for Non-Infectious Pediatric Anterior Uveitis

Ocular Fluid Analysis in Children Reveals Interleukin‐29/Interferon‐λ1 as a Biomarker for Juvenile Idiopathic Arthritis–Associated Uveitis

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