Gabriele Simonini1, Druce Katie2, Rolando Cimaz3, Gary J Macfarlane2, Gareth T Jones2. 1. Rheumatology Unit, Department of Paediatrics, University of Florence, Anna Meyer׳s Children Hospital, viale Pieraccini #24, 50139 Firenze, Italy. Electronic address: gabriele.simonini@unifi.it. 2. Musculoskeletal Research Programme-Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. 3. Rheumatology Unit, Department of Paediatrics, University of Florence, Anna Meyer׳s Children Hospital, viale Pieraccini #24, 50139 Firenze, Italy.
Abstract
OBJECTIVE: To summarize the evidence regarding the effectiveness of switching to a second anti-TNFα treatment in children with autoimmune chronic uveitis (ACU), refractory to the first course of anti-TNFα treatment. METHODS: We conducted a systematic literature review between January 2000 and May 2013 to investigate the efficacy of a second anti-TNFα agent in the treatment of ACU in children (≤16 years) refractory to a first course of a single anti-TNFα treatment, topical and/or systemic steroid therapy and at least one DMARD. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria, at 6 (±2) months of treatment. RESULTS: Among 1086 identified articles, 128 were scrutinized: 10 observational studies, 6 on adalimumab (ADA), 3 on infliximab (INF), and 1 on both, were deemed eligible. Study cohort included 40 children (ADA = 34 and INF = 6), median age 8 years (range 3-16). Nine were males, 28 females (gender not reported in 3), 39/40 were affected by JIA. Seventeen children received etanercept: 11 were switched to ADA, the remaining 6 to INF. All 23 children who previously received INF were switched to ADA. Altogether, 30 children (24 on ADA, 6 on INF) of 40 responded to treatment: 0.75 (95% CI: 0.51-100) was the combined estimate of the proportion of subjects improving. CONCLUSIONS: Despite the fact that no RCT is available and the number of cases is small, this review provides evidence that switching to a second anti-TNFα agent results in improvement of ocular activity for the 75% treated children.
OBJECTIVE: To summarize the evidence regarding the effectiveness of switching to a second anti-TNFα treatment in children with autoimmune chronic uveitis (ACU), refractory to the first course of anti-TNFα treatment. METHODS: We conducted a systematic literature review between January 2000 and May 2013 to investigate the efficacy of a second anti-TNFα agent in the treatment of ACU in children (≤16 years) refractory to a first course of a single anti-TNFα treatment, topical and/or systemic steroid therapy and at least one DMARD. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria, at 6 (±2) months of treatment. RESULTS: Among 1086 identified articles, 128 were scrutinized: 10 observational studies, 6 on adalimumab (ADA), 3 on infliximab (INF), and 1 on both, were deemed eligible. Study cohort included 40 children (ADA = 34 and INF = 6), median age 8 years (range 3-16). Nine were males, 28 females (gender not reported in 3), 39/40 were affected by JIA. Seventeen children received etanercept: 11 were switched to ADA, the remaining 6 to INF. All 23 children who previously received INF were switched to ADA. Altogether, 30 children (24 on ADA, 6 on INF) of 40 responded to treatment: 0.75 (95% CI: 0.51-100) was the combined estimate of the proportion of subjects improving. CONCLUSIONS: Despite the fact that no RCT is available and the number of cases is small, this review provides evidence that switching to a second anti-TNFα agent results in improvement of ocular activity for the 75% treated children.
Authors: Virginia Miraldi Utz; Sabrina Bulas; Sarah Lopper; Matthew Fenchel; Ting Sa; Mitul Mehta; Daniel Ash; Daniel J Lovell; Adam H Kaufman Journal: Pediatr Rheumatol Online J Date: 2019-11-29 Impact factor: 3.054