• Melissa A Lerman, Jon M Burnham, Peter Y Chang, Ebenezer Daniel, C Stephen Foster, Sean Hennessy, Douglas A Jabs, Marshall M Joffe, R Oktay Kaçmaz, Grace A Levy-Clarke, Monte D Mills, Robert B Nussenblatt, James T Rosenbaum, Eric B Suhler, Jennifer E Thorne, and John H Kempen.
• Division of Rheumatology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania 19104, USA. lermanm@email.chop.edu
• J Rheumatol. 2013 Aug 1; 40 (8): 1394-403.

ObjectiveTo evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis.MethodsWe 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.ResultsAmong 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%).ConclusionTreatment 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.

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