Courtney McCracken1, Steven Yeh1,2, Kirsten Jenkins3, Curtis Travers1, Daneka Stryker1, Steven Tommasello1, Kelly A Rouster-Stevens1,3, Scott R Lambert4, Sampath Prahalad1,3,5, Carolyn Drews-Botsch1,2,6, Sheila T Angeles-Han7. 1. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. 2. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA. 3. Children's Healthcare of Atlanta, Atlanta, GA, USA. 4. Department of Ophthalmology, Stanford University, Stanford, GA, USA. 5. Department of Genetics, Emory University School of Medicine, Atlanta, GA, USA. 6. Rollins School of Public Health, Emory University, Atlanta, GA, USA. 7. Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA. Sheila.Angeles-Han@cchmc.org.
Abstract
AIMS: Methotrexate (MTX) is standard treatment in pediatric chronic anterior uveitis (CAU). Addition of tumor necrosis factor-α inhibitors (TNFi) is often needed. We describe the timing and risk factors for TNFi use in children with CAU on MTX. METHODS: In this retrospective study, we reviewed 51 records, and 46 met inclusion criteria. Primary outcome was the addition of TNFi due to active CAU per Standardization of Uveitis Nomenclature criteria. Time to TNFi and factors associated with their addition were assessed using survival analysis models. RESULTS: Of 46 children treated with MTX for uveitis (36 juvenile idiopathic arthritis-associated uveitis, 10 idiopathic CAU), 72% had ocular complications. MTX was started a median of 5.0 months, and TNFi 43 months from uveitis diagnosis. Kaplan-Meier estimates suggest that cumulatively, 12% (95% CI: 4-23%) start TNFi within 6 months of MTX, 21% (12-37%) within 1 year, and 39% (24-54%) within 2 years. On Cox Proportional Hazard regression analysis, children with idiopathic CAU required TNFi earlier in their uveitis course (at 3 months (Hazard Ratio 6.06; 95% confidence interval (1.25-29.41))). Females appeared less likely to require TNFi early. Children treated in 2012 and later were more likely to receive TNFi earlier than those treated before 2012. CONCLUSION: Little is known about optimal time to initiate treatment or factors associated with the need to add TNFi in children on MTX. Children with idiopathic CAU and males required TNFi earlier in their course. Factors associated with these potential risk factors for TNFi warrant further investigation.
AIMS: Methotrexate (MTX) is standard treatment in pediatric chronic anterior uveitis (CAU). Addition of tumor necrosis factor-α inhibitors (TNFi) is often needed. We describe the timing and risk factors for TNFi use in children with CAU on MTX. METHODS: In this retrospective study, we reviewed 51 records, and 46 met inclusion criteria. Primary outcome was the addition of TNFi due to active CAU per Standardization of Uveitis Nomenclature criteria. Time to TNFi and factors associated with their addition were assessed using survival analysis models. RESULTS: Of 46 children treated with MTX for uveitis (36 juvenile idiopathic arthritis-associated uveitis, 10 idiopathic CAU), 72% had ocular complications. MTX was started a median of 5.0 months, and TNFi 43 months from uveitis diagnosis. Kaplan-Meier estimates suggest that cumulatively, 12% (95% CI: 4-23%) start TNFi within 6 months of MTX, 21% (12-37%) within 1 year, and 39% (24-54%) within 2 years. On Cox Proportional Hazard regression analysis, children with idiopathic CAU required TNFi earlier in their uveitis course (at 3 months (Hazard Ratio 6.06; 95% confidence interval (1.25-29.41))). Females appeared less likely to require TNFi early. Children treated in 2012 and later were more likely to receive TNFi earlier than those treated before 2012. CONCLUSION: Little is known about optimal time to initiate treatment or factors associated with the need to add TNFi in children on MTX. Children with idiopathic CAU and males required TNFi earlier in their course. Factors associated with these potential risk factors for TNFi warrant further investigation.
Authors: Ross E Petty; Taunton R Southwood; Prudence Manners; John Baum; David N Glass; Jose Goldenberg; Xiaohu He; Jose Maldonado-Cocco; Javier Orozco-Alcala; Anne-Marie Prieur; Maria E Suarez-Almazor; Patricia Woo Journal: J Rheumatol Date: 2004-02 Impact factor: 4.666
Authors: Fasika Woreta; Jennifer E Thorne; Douglas A Jabs; Sanjay R Kedhar; James P Dunn Journal: Am J Ophthalmol Date: 2006-12-20 Impact factor: 5.258
Authors: Clive Edelsten; Vickie Lee; Christopher R Bentley; Jack J Kanski; Elizabeth M Graham Journal: Br J Ophthalmol Date: 2002-01 Impact factor: 4.638
Authors: Roos A W Wennink; Viera Kalinina Ayuso; Weiyang Tao; Eveline M Delemarre; Joke H de Boer; Jonas J W Kuiper Journal: Transl Vis Sci Technol Date: 2022-02-01 Impact factor: 3.283