Infliximab may be beneficial in children with chronic noninfectious uveitis

In one of the largest series describing long-term infliximab therapy in pediatric uveitis, researchers showed that 16 children, followed for a median of 26 months, seemed to tolerate therapy well. Visual acuity remained stable and 69 percent were able to discontinue corticosteroid ophthalmic drops.

Of the 16 children (29 eyes) in the study, six had associated extraocular inflammatory conditions, four had juvenile rheumatoid arthritis and 10 had isolated uveitis with no systemic disease at all.

As in most published case series, 15 of the 16 children in this study were treated with a combination of infliximab and methotrexate. As a result, any clinical improvement must be attributed to the combination rather than to infliximab alone. Treatment with methotrexate and infliximab was associated with resolution of or two-step reduction in anterior chamber cell inflammation at three, six, nine, and 12 months of treatment.

Among their findings:

• Median maintenance infliximab dose was 8.2 mg/kg.
• Median interval between infliximab infusions was 5.6 weeks.
• At one year, 64% achieved zero ocular inflammation, and 79% had zero inflammation or a two-step decline in inflammation. 
• Topical glucocorticoids were discontinued in 69%, and 58% remained free of uveitis recurrence at one year 

Although these results need to be confirmed in a prospective, controlled trial, the authors conclude that infliximab may be a beneficial therapy for chronic noninfectious uveitis in children.