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  • Pediatric Ophth/Strabismus, Uveitis

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

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

    Alternative biologic therapy (ABT) has been advanced as a treatment option for children with uveitis whose disease is unresponsive to both methotrexate (MTX) and conventional tumor necrosis factor inhibitors (TNFis).

    Study design

    This retrospective, nonrandomized clinical study analyzed outcomes in 52 children (aged <18 years) with noninfectious chronic anterior uveitis requiring immunomodulatory therapy who were seen at a single US-based institution. Fifteen children had their uveitis controlled on MTX monotherapy, 28 received TNFis (infliximab or adalimumab) following MTX failure, and 9 received ABT (tocilizumab, abatacept, or rituximab) following both MTX and TNFi failure.


    In the patients who were advanced to ABT, there was successful control of chronic anterior uveitis, with topical steroid eye drop dosage reduced to ≤2 drops/day in 7 of the 9 patients. No new ocular complications were noted after the switch to ABT, despite there being more baseline ocular complications in this group compared with the other 2 treatment groups.


    While the authors checked for presence of antibodies to TNFi in patients who failed conventional therapy, the role of their presence on the response to the ABT agents is unclear. Dosing strategies for children on TNFi in the study were not uniform, and the length of follow-up for patients was also variable.

    Clinical significance

    Since conventional treatment with MTX and/or TNFis can fail in about a third of children with chronic anterior uveitis, this study provides additional insight on top of the existing literature that ABTs could be helpful in this subset of patients, with a safe outcome and remission of disease. Further prospective randomized trials in children who have failed standard therapy should be pursued.

    Financial Disclosures: Dr. Sherveen Salek discloses no financial relationships.