Response of pediatric uveitis to tumor necrosis factor-α inhibitors

Melissa A. Lerman, Jon M. Burnham, Peter Y. Chang, Ebenezer Daniel, C. Stephen Foster, Sean Hennessy, Douglas A. Jabs, Marshall M. Joffe, R. Oktay Kacmaz, Grace A. Levy-Clarke, Monte D. Mills, Robert B. Nussenblatt, James (Jim) Rosenbaum, Eric Suhler, Jennifer E. Thorne, John H. Kempen

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objective. To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis. Methods. We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses. Results. Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%-87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%-76%). Diagnoses of JIA or AU were associated with greater likelihood of success, as was the oligoarticular subtype among JIA cases. In a multivariable model, compared to those with JIA-associated AU, those with neither or with JIA or AU alone had a 75%-80% lower rate of achieving quiescence under anti-TNF, independent of the number of immunomodulators previously or concomitantly prescribed. Uveitis reactivated within 12 months of achieving quiescence in 14% of those continuing anti-TNF (95% CI 6%-31%). The incidence of discontinuation for adverse effects was 8%/year (95% CI 1%-43%). Conclusion. Treatment with anti-TNF was successful and sustained in a majority of children with noninfectious uveitis, and treatment-limiting toxicity was infrequent. JIA-associated AU may be especially responsive to anti-TNF.

Original languageEnglish (US)
Pages (from-to)1394-1403
Number of pages10
JournalJournal of Rheumatology
Volume40
Issue number8
DOIs
StatePublished - Aug 2013

Fingerprint

Uveitis
Juvenile Arthritis
Anterior Uveitis
Tumor Necrosis Factor-alpha
Pediatrics
Adrenal Cortex Hormones
Ophthalmic Solutions
Immunologic Factors
Rheumatology
Therapeutics
Incidence

Keywords

  • Juvenile idiopathic arthritis
  • Tumor necrosis factor antagonist
  • Uveitis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

Lerman, M. A., Burnham, J. M., Chang, P. Y., Daniel, E., Stephen Foster, C., Hennessy, S., ... Kempen, J. H. (2013). Response of pediatric uveitis to tumor necrosis factor-α inhibitors. Journal of Rheumatology, 40(8), 1394-1403. https://doi.org/10.3899/jrheum.121180

Response of pediatric uveitis to tumor necrosis factor-α inhibitors. / Lerman, Melissa A.; Burnham, Jon M.; Chang, Peter Y.; Daniel, Ebenezer; Stephen Foster, C.; Hennessy, Sean; Jabs, Douglas A.; Joffe, Marshall M.; Oktay Kacmaz, R.; Levy-Clarke, Grace A.; Mills, Monte D.; Nussenblatt, Robert B.; Rosenbaum, James (Jim); Suhler, Eric; Thorne, Jennifer E.; Kempen, John H.

In: Journal of Rheumatology, Vol. 40, No. 8, 08.2013, p. 1394-1403.

Research output: Contribution to journalArticle

Lerman, MA, Burnham, JM, Chang, PY, Daniel, E, Stephen Foster, C, Hennessy, S, Jabs, DA, Joffe, MM, Oktay Kacmaz, R, Levy-Clarke, GA, Mills, MD, Nussenblatt, RB, Rosenbaum, JJ, Suhler, E, Thorne, JE & Kempen, JH 2013, 'Response of pediatric uveitis to tumor necrosis factor-α inhibitors', Journal of Rheumatology, vol. 40, no. 8, pp. 1394-1403. https://doi.org/10.3899/jrheum.121180
Lerman MA, Burnham JM, Chang PY, Daniel E, Stephen Foster C, Hennessy S et al. Response of pediatric uveitis to tumor necrosis factor-α inhibitors. Journal of Rheumatology. 2013 Aug;40(8):1394-1403. https://doi.org/10.3899/jrheum.121180
Lerman, Melissa A. ; Burnham, Jon M. ; Chang, Peter Y. ; Daniel, Ebenezer ; Stephen Foster, C. ; Hennessy, Sean ; Jabs, Douglas A. ; Joffe, Marshall M. ; Oktay Kacmaz, R. ; Levy-Clarke, Grace A. ; Mills, Monte D. ; Nussenblatt, Robert B. ; Rosenbaum, James (Jim) ; Suhler, Eric ; Thorne, Jennifer E. ; Kempen, John H. / Response of pediatric uveitis to tumor necrosis factor-α inhibitors. In: Journal of Rheumatology. 2013 ; Vol. 40, No. 8. pp. 1394-1403.
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AU - Lerman, Melissa A.

AU - Burnham, Jon M.

AU - Chang, Peter Y.

AU - Daniel, Ebenezer

AU - Stephen Foster, C.

AU - Hennessy, Sean

AU - Jabs, Douglas A.

AU - Joffe, Marshall M.

AU - Oktay Kacmaz, R.

AU - Levy-Clarke, Grace A.

AU - Mills, Monte D.

AU - Nussenblatt, Robert B.

AU - Rosenbaum, James (Jim)

AU - Suhler, Eric

AU - Thorne, Jennifer E.

AU - Kempen, John H.

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N2 - Objective. To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis. Methods. We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses. Results. Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%-87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%-76%). Diagnoses of JIA or AU were associated with greater likelihood of success, as was the oligoarticular subtype among JIA cases. In a multivariable model, compared to those with JIA-associated AU, those with neither or with JIA or AU alone had a 75%-80% lower rate of achieving quiescence under anti-TNF, independent of the number of immunomodulators previously or concomitantly prescribed. Uveitis reactivated within 12 months of achieving quiescence in 14% of those continuing anti-TNF (95% CI 6%-31%). The incidence of discontinuation for adverse effects was 8%/year (95% CI 1%-43%). Conclusion. Treatment with anti-TNF was successful and sustained in a majority of children with noninfectious uveitis, and treatment-limiting toxicity was infrequent. JIA-associated AU may be especially responsive to anti-TNF.

AB - Objective. To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis. Methods. We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses. Results. Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%-87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%-76%). Diagnoses of JIA or AU were associated with greater likelihood of success, as was the oligoarticular subtype among JIA cases. In a multivariable model, compared to those with JIA-associated AU, those with neither or with JIA or AU alone had a 75%-80% lower rate of achieving quiescence under anti-TNF, independent of the number of immunomodulators previously or concomitantly prescribed. Uveitis reactivated within 12 months of achieving quiescence in 14% of those continuing anti-TNF (95% CI 6%-31%). The incidence of discontinuation for adverse effects was 8%/year (95% CI 1%-43%). Conclusion. Treatment with anti-TNF was successful and sustained in a majority of children with noninfectious uveitis, and treatment-limiting toxicity was infrequent. JIA-associated AU may be especially responsive to anti-TNF.

KW - Juvenile idiopathic arthritis

KW - Tumor necrosis factor antagonist

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