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Immunomodulatory therapy with tumour necrosis factor α inhibitors in children with antinuclear antibody-associated chronic anterior uveitis: long-term results
  1. Deshka Doycheva1,2,
  2. Manfred Zierhut1,
  3. Gunnar Blumenstock3,
  4. Nicole Stuebiger4,
  5. Kai Januschowski1,
  6. Bogomil Voykov1,
  7. Christoph Deuter1
  1. 1Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
  2. 2Knappschaft Eye Hospital, Sulzbach, Germany
  3. 3Department of Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany
  4. 4Department of Ophthalmology, Charité, University Medicine Berlin, Berlin, Germany
  1. Correspondence to Dr Deshka Doycheva, Centre for Ophthalmology, University of Tuebingen, Schleichstr. 12, Tuebingen 72076, Germany; deshka.doycheva{at}med.uni-tuebingen.de

Abstract

Aim The aim of the study was to assess the long-term efficacy and tolerability of tumour necrosis factor α (TNFα) inhibitors in the therapy of children with refractory antinuclear antibody (ANA)-associated chronic anterior uveitis.

Methods Retrospective analysis of 31 children with ANA-associated uveitis, treated with TNFα inhibitors with a follow-up period of at least 2 years. The outcome measures included: control of inflammation, corticosteroid-sparing potential and side effects.

Results Twenty-three children (74%) were treated with adalimumab, five children (16%) with infliximab and three children (10%) with etanercept. Control of uveitis, defined as 0 anterior chamber cells while on ≤2 drops/day topical corticosteroids, was achieved in 22 of 31 patients (71%) after 1 year (95% CI 52% to 86%), and in 21 of 29 patients (72%) after 2 years of treatment (95% CI 53% to 87%). Control of uveitis was observed in 18 of 23 children (78%) treated with adalimumab, and in two of five children (40%) treated with infliximab. In all children treated with etanercept, no sufficient inflammatory control was found. Systemic corticosteroids could be discontinued in 71% (12/17 children) and topical corticosteroids in 55% (17/31) of the patients. Treatment-related side effects were found in nine children (29%, rate: 0.10/patient-year).

Conclusions Our data show that adalimumab and infliximab have beneficial effects in the therapy of severe ANA-associated anterior uveitis in children.

  • Inflammation

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