Anti-TNF therapy for childhood and adolescent uveitis

Abstract

Childhood uveitis is the third most common cause of blindness in the pediatric population (1). Numerous side effects of chronic corticosteroid use have prompted a quest for a viable steroid-sparing treatment. Our purpose is to describe the corticosteroid-sparing effect of anti-TNF therapy in chronic childhood and adolescent uveitis. Retrospective longitudinal case series of patients started on anti-TNF therapy for chronic uveitis. Major outcome measures were corticosteroid-sparing success, adverse events, inflammation control, need for and ability to taper concurrent treatments assessed at 1-, 3-, 6-, 12-, 18-, and 24-month intervals. Nineteen eyes of 10 patients who used adalimumab or infliximab and followed for an average of 12 months were identified. Three patients had anterior uveitis and 7 had posterior segment uveitis. All patients with posterior segment inflammation improved significantly with anti-TNF therapy. 84% of eyes with anterior chamber inflammation improved or remained stable. Four patients (40%) required two cycles of therapy due to either relapse or failure. All patients were successfully weaned to systemic steroid dose of less than 7 mg/day without relapse, but 33% required lowdose maintenance steroids. Half of patients required at least one other non-biologic systemic immunosuppressive after 6 months. One serious adverse event (anaphylactic reaction to infliximab) was identified. This is the first study of its kind looking at outcomes for both anterior and posterior uveitis after relatively long term treatment with anti-TNF therapy in children. Anti-TNF antibody biologics improve inflammation control and offer a steroid-sparing therapy in pediatric uveitis patients.