Response of pediatric uveitis to tumor necrosis factor-α inhibitors.
J Rheumatol
; 40(8): 1394-403, 2013 Aug.
Article
en En
| MEDLINE
| ID: mdl-23818712
ABSTRACT
OBJECTIVE:
To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis.METHODS:
We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses.RESULTS:
Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%-87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%-76%). Diagnoses of JIA or AU were associated with greater likelihood of success, as was the oligoarticular subtype among JIA cases. In a multivariable model, compared to those with JIA-associated AU, those with neither or with JIA or AU alone had a 75%-80% lower rate of achieving quiescence under anti-TNF, independent of the number of immunomodulators previously or concomitantly prescribed. Uveitis reactivated within 12 months of achieving quiescence in 14% of those continuing anti-TNF (95% CI 6%-31%). The incidence of discontinuation for adverse effects was 8%/year (95% CI 1%-43%).CONCLUSION:
Treatment with anti-TNF was successful and sustained in a majority of children with noninfectious uveitis, and treatment-limiting toxicity was infrequent. JIA-associated AU may be especially responsive to anti-TNF.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Uveítis
/
Inmunoglobulina G
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Uveítis Anterior
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Factor de Necrosis Tumoral alfa
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Receptores del Factor de Necrosis Tumoral
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Anticuerpos Monoclonales Humanizados
/
Anticuerpos Monoclonales
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adolescent
/
Child
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Child, preschool
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Female
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Humans
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Infant
/
Male
Idioma:
En
Revista:
J Rheumatol
Año:
2013
Tipo del documento:
Article
País de afiliación:
Estados Unidos