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Non-Infectious Chronic Uveitis in Childhood: Assessment and Treatment in the Biological Era

  • Pediatric Rheumatology (G Martini, Section Editor)
  • Published:
Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Abstract

Purpose of review

Report of currently available medical strategies for treatment of childhood chronic uveitis in the biologic era.

Recent Findings

The management of non-infectious chronic uveitis in children is based on immunomodulatory treatment. In case of failure to conventional disease-modifying anti-rheumatic drugs (cDMARDs) and/or frequent flares, tumor necrosis factor-alpha (TNF-α) blocking agents represent the first biologic choice. Adalimumab is the TNF-α inhibitor more frequently adopted. Two multicenter, double blind, randomized, placebo-controlled trials stated its efficacy and safety in this clinical setting.

For refractory disease not responsive to TNF-α inhibitors, emerging biologic therapies have been reported. Most of the current literature refers to expert opinion and remains non-standardized. However, retrospective studies and short case series report tocilizumab, abatacept, and rituximab as promising biologic alternatives in patients with refractory, sight-threatening uveitis even in children.

Summary

The role of anti-TNF-α inhibitor in chronic uveitis therapy met unanimous level of agreement. Rescue therapy approach still remains controversial. Randomized controlled trials and large series with long-term follow-up are mandatory to assess efficacy and cost effectiveness in this challenging disease.

Trial registration

ClinicalTrials.gov ID: NCT01279954. ClinicalTrials.gov ID: NCT04088409

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Author notes

  1. Roberta Ponti and Maria Vincenza Mastrolia contributed equally to this work.

Authors and Affiliations

  1. Pediatric Residency, University of Udine, Via delle Scienze, 206, 33100, Udine, UD, Italy

    Roberta Ponti

  2. Rheumatology Unit, Pediatric Residency, Anna Meyer Children’s University Hospital, University of Florence, 50121, Florence, FI, Italy

    Maria Vincenza Mastrolia

  3. Rheumatology Unit, NEUROFARBA Department, Anna-Meyer Children’s University Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy

    Gabriele Simonini

Authors
  1. Roberta Ponti
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  2. Maria Vincenza Mastrolia
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  3. Gabriele Simonini
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Correspondence to Gabriele Simonini.

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Roberta Ponti declares that she has no conflict of interest. Maria Vincenza Mastrolia declares that she has no conflict of interest. Gabriel Simonini declares that he has no conflict of interest.

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Ponti, R., Mastrolia, M.V. & Simonini, G. Non-Infectious Chronic Uveitis in Childhood: Assessment and Treatment in the Biological Era. Curr Treat Options in Rheum 6, 228–244 (2020). https://doi.org/10.1007/s40674-020-00151-0

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