Carolina Birolo1,2, Maria Elisabetta Zannin1,2, Svetlana Arsenyeva1,2, Rolando Cimaz1,2, Elisabetta Miserocchi1,2, Margarita Dubko1,2, Chantal Job Deslandre1,2, Fernanda Falcini1,2, Maria Alessio1,2, Francesco La Torre1,2, Ekaterina Denisova1,2, Giorgia Martini1,2, Irina Nikishina1,2, Francesco Zulian3,4. 1. From the Department of Pediatrics, Rheumatology Unit, University of Padua, Padua, Italy; Scientific Research Institute of Rheumatology RAMS, Moscow, Russian Federation; A. Meyer Children's Hospital, Rheumatology Unit, and Department of Internal Medicine, Section of Rheumatology, University of Florence, Florence, Italy; Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy; Saint-Petersburg Pediatric Medical Academy, Saint-Petersburg, Russian Federation; Rheumatology Service, Cochin Hospital, Paris, France; Department of Pediatrics, Rheumatology Unit, University of Naples Federico II, Naples, Italy; Department of Pediatrics, Antonio Perrino Hospital, Brindisi, Italy; Helmgoltz Moscow Research Institute of Eye Diseases, Moscow, Russian Federation. 2. C. Birolo, MD, Resident in Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua; M.E. Zannin, MD, PhD, Assistant Professor of Ophthalmology, Department of Pediatrics, Rheumatology Unit, University of Padua; S. Arsenyeva, MD, PhD, Associate Professor of Ophthalmology, Scientific Research Institute of Rheumatology RAMS; R. Cimaz, MD, Professor of Pediatrics, A. Meyer Children's Hospital, Rheumatology Unit, University of Florence; E. Miserocchi, MD, PhD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Scientific Institute San Raffaele; M. Dubko, MD, Associate Professor of Pediatrics, Saint-Petersburg Pediatric Medical Academy; C.J. Deslandre, MD, Associate Professor of Pediatrics, Rheumatology Service, Cochin Hospital; F. Falcini, MD, Associate Professor of Pediatrics, Department of Internal Medicine, Section of Rheumatology, University of Florence; M. Alessio, MD, Associate Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Naples Federico II; F. La Torre, MD, Assistant Professor of Pediatrics, Department of Pediatrics, Antonio Perrino Hospital; E. Denisova, MD, Assistant Professor of Ophthalmology, Helmgoltz Moscow Research Institute of Eye Diseases; G. Martini, MD, PhD, Assistant Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua; I. Nikishina, MD, Associate Professor of Pediatrics, Scientific Research Institute of Rheumatology RAMS; F. Zulian, MD, Associate Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua. 3. From the Department of Pediatrics, Rheumatology Unit, University of Padua, Padua, Italy; Scientific Research Institute of Rheumatology RAMS, Moscow, Russian Federation; A. Meyer Children's Hospital, Rheumatology Unit, and Department of Internal Medicine, Section of Rheumatology, University of Florence, Florence, Italy; Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy; Saint-Petersburg Pediatric Medical Academy, Saint-Petersburg, Russian Federation; Rheumatology Service, Cochin Hospital, Paris, France; Department of Pediatrics, Rheumatology Unit, University of Naples Federico II, Naples, Italy; Department of Pediatrics, Antonio Perrino Hospital, Brindisi, Italy; Helmgoltz Moscow Research Institute of Eye Diseases, Moscow, Russian Federation. zulian@pediatria.unipd.it. 4. C. Birolo, MD, Resident in Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua; M.E. Zannin, MD, PhD, Assistant Professor of Ophthalmology, Department of Pediatrics, Rheumatology Unit, University of Padua; S. Arsenyeva, MD, PhD, Associate Professor of Ophthalmology, Scientific Research Institute of Rheumatology RAMS; R. Cimaz, MD, Professor of Pediatrics, A. Meyer Children's Hospital, Rheumatology Unit, University of Florence; E. Miserocchi, MD, PhD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Scientific Institute San Raffaele; M. Dubko, MD, Associate Professor of Pediatrics, Saint-Petersburg Pediatric Medical Academy; C.J. Deslandre, MD, Associate Professor of Pediatrics, Rheumatology Service, Cochin Hospital; F. Falcini, MD, Associate Professor of Pediatrics, Department of Internal Medicine, Section of Rheumatology, University of Florence; M. Alessio, MD, Associate Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Naples Federico II; F. La Torre, MD, Assistant Professor of Pediatrics, Department of Pediatrics, Antonio Perrino Hospital; E. Denisova, MD, Assistant Professor of Ophthalmology, Helmgoltz Moscow Research Institute of Eye Diseases; G. Martini, MD, PhD, Assistant Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua; I. Nikishina, MD, Associate Professor of Pediatrics, Scientific Research Institute of Rheumatology RAMS; F. Zulian, MD, Associate Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua. zulian@pediatria.unipd.it.
Abstract
OBJECTIVE: Abatacept (ABA) has recently been proposed as second-line treatment in patients with juvenile idiopathic arthritis (JIA)-associated uveitis refractory to anti-tumor necrosis factor-α (anti-TNF) agents, but little is known about its efficacy as a first-line approach. The aim of the present study was to compare the safety and efficacy of ABA as a first-line biological agent (ABA-1) with that of ABA as a second-line treatment after 1 or more anti-TNF agents (ABA-2), in patients with severe JIA-related uveitis. METHODS: In this multicenter study, we collected data on patients with severe JIA-related uveitis treated with ABA as a first-line or second-line biological agent. Changes in frequency of uveitis flares/year and ocular complications before and after ABA treatment, clinical remission, and side effects were recorded. RESULTS: Thirty-five patients with a mean age of 10.8 years were treated with ABA for a mean period of 19.6 months. In 4 patients, ABA administration was discontinued, owing to inefficacy on arthritis in 3 cases and allergic reaction in 1. Thirty-one patients, 14 in the ABA-1 group and 17 in the ABA-2 group, completed the 12-month followup period; of these, 17 (54.8%) had clinical remission. The mean frequency of uveitis flares decreased from 4.1 to 1.2 in the ABA-1 group (p = 0.002) and from 3.7 to 1.2 in the ABA-2 group (p = 0.004). Preexisting ocular complications improved or remained stable in all but 5 patients, all in the ABA-2 group. No significant difference was found between the efficacy of the 2 treatment modalities. ABA confirmed its good safety profile. CONCLUSION: ABA, used as first-line biological treatment or after 1 or more anti-TNF agents, induces a comparable improvement in severe refractory JIA-related uveitis.
OBJECTIVE: Abatacept (ABA) has recently been proposed as second-line treatment in patients with juvenile idiopathic arthritis (JIA)-associated uveitis refractory to anti-tumornecrosis factor-α (anti-TNF) agents, but little is known about its efficacy as a first-line approach. The aim of the present study was to compare the safety and efficacy of ABA as a first-line biological agent (ABA-1) with that of ABA as a second-line treatment after 1 or more anti-TNF agents (ABA-2), in patients with severe JIA-related uveitis. METHODS: In this multicenter study, we collected data on patients with severe JIA-related uveitis treated with ABA as a first-line or second-line biological agent. Changes in frequency of uveitis flares/year and ocular complications before and after ABA treatment, clinical remission, and side effects were recorded. RESULTS: Thirty-five patients with a mean age of 10.8 years were treated with ABA for a mean period of 19.6 months. In 4 patients, ABA administration was discontinued, owing to inefficacy on arthritis in 3 cases and allergic reaction in 1. Thirty-one patients, 14 in the ABA-1 group and 17 in the ABA-2 group, completed the 12-month followup period; of these, 17 (54.8%) had clinical remission. The mean frequency of uveitis flares decreased from 4.1 to 1.2 in the ABA-1 group (p = 0.002) and from 3.7 to 1.2 in the ABA-2 group (p = 0.004). Preexisting ocular complications improved or remained stable in all but 5 patients, all in the ABA-2 group. No significant difference was found between the efficacy of the 2 treatment modalities. ABA confirmed its good safety profile. CONCLUSION: ABA, used as first-line biological treatment or after 1 or more anti-TNF agents, induces a comparable improvement in severe refractory JIA-related uveitis.
Authors: Sheila T Angeles-Han; Sarah Ringold; Timothy Beukelman; Daniel Lovell; Carlos A Cuello; Mara L Becker; Robert A Colbert; Brian M Feldman; Gary N Holland; Polly J Ferguson; Harry Gewanter; Jaime Guzman; Jennifer Horonjeff; Peter A Nigrovic; Michael J Ombrello; Murray H Passo; Matthew L Stoll; C Egla Rabinovich; H Nida Sen; Rayfel Schneider; Olha Halyabar; Kimberly Hays; Amit Aakash Shah; Nancy Sullivan; Ann Marie Szymanski; Marat Turgunbaev; Amy Turner; James Reston Journal: Arthritis Care Res (Hoboken) Date: 2019-04-25 Impact factor: 4.794
Authors: Sheila T Angeles-Han; Sarah Ringold; Timothy Beukelman; Daniel Lovell; Carlos A Cuello; Mara L Becker; Robert A Colbert; Brian M Feldman; Gary N Holland; Polly J Ferguson; Harry Gewanter; Jaime Guzman; Jennifer Horonjeff; Peter A Nigrovic; Michael J Ombrello; Murray H Passo; Matthew L Stoll; C Egla Rabinovich; H Nida Sen; Rayfel Schneider; Olha Halyabar; Kimberly Hays; Amit Aakash Shah; Nancy Sullivan; Ann Marie Szymanski; Marat Turgunbaev; Amy Turner; James Reston Journal: Arthritis Rheumatol Date: 2019-04-25 Impact factor: 10.995