Tocilizumab may be helpful in children with uveitis refractive to anti-TNF agents

This retrospective review is the first head-to-head study of abatacept vs tocilizumab in children with childhood chronic noninfectious uveitis (CCU).

Study design

Eighteen patients with CCU treated at a single center in Italy, who were refractory to ≥1 disease-modifying antirheumatic drug (DMARD) and ≥1 anti–tumor necrosis factor (anti-TNF) agent and were subsequently treated with abatacept or tocilizumab, were included in the study. Medical record data were reviewed at 3-month intervals for uveitis activity as well as for the presence or absence of ocular complications. The primary outcome was remission, defined as absence of flares for ≥6 months.

Outcomes

All patients receiving tocilizumab achieved remission, compared with 50% of patients receiving abatacept; mean time to achieve remission was similar between the groups. Five patients discontinued treatment due to ocular remission; none of the patients given tocilizumab and 3 patients given abatacept had flares following treatment discontinuation.

Limitations

This was a retrospective study with a very small patient population. As with many uveitis studies, the patients could not be stratified by disease subtype and had to be studied together despite having different etiology and systemic diseases associated with uveitis, and therefore they may have had different responses to treatment.

Clinical significance

Despite the significant limitations of a small and heterogeneous sample size, this study shows interesting trends that are clinically helpful in children with uveitis who are failing anti-TNF therapy. Currently, there is little to no guidance as to which agent should be used after anti-TNF failure, and these results indicated that tocilizumab may be more effective than other agents in inducing remission, whether patients are currently on the medication or have discontinued after a course of treatment.