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

  • Inflammatory Disorders
  • Published:
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Abstract

Purpose

This study aimed to report the clinical outcome of children with uveitis treated with anti-tumor necrosis factor alpha (TNF-α) agents.

Methods

This included a retrospective cohort study. Children with uveitis treated with infliximab or adalimumab in 2008–2014 at five dedicated uveitis clinics were identified by database search. Their medical records were reviewed for demographic data, clinical presentation, ocular complications, and visual outcome. Systemic side effects and the steroid-sparing effect of treatment were documented.

Results

The cohort included 24 patients (43 eyes) of whom 14 received infliximab and 10 received adalimumab after failing conventional immunosuppression therapy. Mean age was 9.3 ± 4.0 years. The most common diagnosis was juvenile idiopathic arthritis-related uveitis (n = 10), followed by Behçet’s disease (n = 4), sarcoidosis (n = 1), and ankylosing spondylitis (n = 1); eight had idiopathic uveitis. Ocular manifestations included panuveitis in 20 eyes (46.5%), chronic anterior uveitis in 19 (44.2%), and intermediate uveitis in 4 (9.3%). The duration of biologic treatment ranged from 6 to 72 months. During the 12 months prior to biologic treatment, while on conventional immunosuppressive therapy, mean visual acuity deteriorated from 0.22 to 0.45 logMAR, with a trend of recovery to 0.25 at 3 months after initiation of biologic treatment, remaining stable thereafter. A full corticosteroid-sparing effect was demonstrated in 16 of the 19 patients (84.2%) for whom data were available. Treatment was well tolerated.

Conclusions

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.

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Acknowledgements

We would like to thank Mrs.Dorit Karesh for her contribution to the statistical analysis.

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel

    Iris Deitch, Ronit Friling & Michal Kramer

  2. Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel

    Radgonde Amer

  3. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Radgonde Amer

  4. Moorfields Eye Hospital, London, UK

    Oren Tomkins-Netzer

  5. Institute of Ophthalmology, University College of London, London, UK

    Oren Tomkins-Netzer

  6. Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Zohar Habot-Wilner

  7. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Zohar Habot-Wilner, Ronit Friling & Michal Kramer

  8. Pediatric Ophthalmology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

    Ronit Friling

  9. Maccabi Health Care Services, Tel Aviv, Israel

    Ron Neumann

Authors
  1. Iris Deitch
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  2. Radgonde Amer
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Correspondence to Michal Kramer.

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Conflict of interest

Dr. Michal Kramer served as an advisor to Abbvie and as principal investigator in a clinical trial, not related to this study. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Deitch, I., Amer, R., Tomkins-Netzer, O. et al. The effect of anti-tumor necrosis factor alpha agents on the outcome in pediatric uveitis of diverse etiologies. Graefes Arch Clin Exp Ophthalmol 256, 801–808 (2018). https://doi.org/10.1007/s00417-018-3928-6

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  • DOI: https://doi.org/10.1007/s00417-018-3928-6

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