Nonetheless biologic modifier therapies are available treatment strategies for sight-threatening uveitis in children, the lack of evidence from head-to-head randomized controlled studies limits our understanding of timing of therapy when to commence therapy, which agent to choose and how long to continue treatment, and, in case of failure, if switching to another anti-TNF-alpha strategy might be eventually an option.
Researchers have compared the efficacy of Adalimumab ( Humira ) when used as first anti-TNF-alpha therapy versus Adalimumab used after the failure of a previous anti-TNF-alpha ( Infliximab ) in an open-label, comparative, multi-center, cohort study of childhood chronic uveitis.
26 patients ( 14 F, 12 M; median age: 8.6 years ) with refractory, non-infectious active uveitis were enrolled.
Due to the refractory course of uveitis to previous DMARD treatment, Group 1 received Adalimumab ( 24 mg/sq mt, every 2 weeks ), as first anti-TNF-alpha choice; Group 2 received Adalimumab, as second anti-TNF-alpha drug, due to the loss of efficacy of Infliximab, administered after a period of at least 1 year.
Both groups received Adalimumab for at least 1 year of treatment.
Primary outcome was, once remission was achieved, the time to a first relapse.
14 children ( 10 with juvenile idiopathic arthritis, 3 with idiopathic uveitis, 1 with Behçet's disease ) were recruited in Group 1; 12 children ( 7 with juvenile idiopathic arthritis, 3 with idiopathic uveitis, 1 with early-onset sarcoidosis, 1 with Behçet's disease ) in Group 2.
Group 2 showed a lower probability to steroid discontinuation during the first 12 months of treatment ( p less than 0.04 ).
In long-term follow-up, Group 1 had higher probability of uveitis remission during the time of treatment on Adalimumab ( median ±SE: 18 ±1.1 vs 4 ±0.6 months, CI 95%: 15.6-27.5 vs 2.7-5.2; p less than 0.002 ).
In conclusion, even if limited to a relatively small group, the study suggests a better efficacy of Adalimumab when used as first anti-TNF-alpha treatment in childhood chronic uveitis. ( Xagena )
Simonini G et al, Pediatr Rheumatol Online J 2013;11:16. doi: 10.1186/1546-0096-11-16. eCollection 2013