APR 30, 2014
By Michael G. Haas, MD
Comprehensive Ophthalmology
This chart review found that adalimumab and infliximab may be effective and well-tolerated in children with severe antinuclear antibody-associated (ANA) anterior uveitis.
Subjects included 31 children with refractory ANA-associated uveitis treated with tumor necrosis factor α (TNFα) inhibitors and followed up for at least two years. Treatment ranged from 14 to 126 months, with a mean of 49 months.
Control of uveitis, defined as no anterior chamber cells while on ≤ 2 drops per day of topical corticosteroids, was achieved in 71 percent of patients after one year and in 72 percent after two years.
Control of uveitis was observed in 18 of 23 patients (78 percent) treated with adalimumab and in two of five (40 percent) treated with infliximab. All three children treated with etanercept showed no significant reduction in inflammation.
Systemic corticosteroids were able to be discontinued in 71 percent of patients and topical corticosteroids in 55 percent. Treatment-related side effects were found in nine children (29 percent, rate: 0.10/patient-year).
The authors recommend anti-TNFα therapy in refractory pediatric uveitis when conventional immunosuppressive treatment has failed. They write that adalimumab is preferable because of its comfortable application‑which does not require hospitalization‑easy management, fewer side effects and superior efficacy in comparison with other TNFα-blocking agents.