• Pediatric Ophth/Strabismus, Uveitis

    Review of: Alternative biologic therapy in children failing conventional TNFα inhibitors for refractory, non-infectious, chronic anterior uveitis

    Miraldi Utz V, Angeles-Han S, Mwase N, et al. American Journal of Ophthalmology, in press 2022

    Investigators evaluated the use of alternative biologic agents in children with chronic anterior uveitis who had failed treatment with methotrexate and at least one tumor necrosis factor inhibitor (TNFi).

    Study design

    This was a retrospective chart review of children with chronic noninfectious anterior uveitis from one US-based tertiary center who were prospectively enrolled into the Longitudinal Outcomes of Children with Uveitis Study. The main outcome was the success of abatacept, tocilizumab, and/or golimumab therapies in patients who had failed traditional TNFi therapy. Ocular complications noted included glaucoma, cataracts, ocular hypertension, and synechiae.

    Outcomes

    Fifty-two children were included in the cohort: 15 were on methotrexate monotherapy, 28 had advanced to conventional TNFis, and 9 children were treated with the alternative biologic agents. All of the 9 children who had failed TNFi therapy and were given the alternative biologics had positive antinuclear antibodies, and 8 were also receiving additional therapy with nonbiologic disease-modifying antirheumatic drugs. There were no differences in age of onset, visual acuity, baseline ocular complications, incidence of ocular surgeries, and duration of disease between the 3 different treatment groups. The total ocular complication rate was 3.4 per person in the alternative therapy group, compared with 0.7 per person in the methotrexate group and 1.5 per person in the TNFi group. All groups had similar rates of ocular surgeries.

    Limitations

    Given the small sample sizes, the results have limited generalizability. There were differences in treatment algorithms and dosing regimens between patients, which makes the treatments difficult to compare.

    Clinical significance

    In conclusion, treatment of chronic noninfectious uveitis can be challenging. Alternative approaches include the use of abatacept, tocilizumab, and/or golimumab. Future larger prospective randomized studies will be needed to ascertain specific dosing regimens and optimal treatment patterns.