Current evidence of anti-TNF alpha treatment efficacy in childhood chronic uveitis

a systematic review and meta-analysis approach comparing the different drugs

K. Druce, G. Simonini, R. Cimaz, G. J. Macfarlane, G. T. Jones

Research output: Contribution to journalAbstract

Abstract

Childhood autoimmune chronic uveitis (ACU) is associated with serious long-term complications including blindness. In ACU refractory to treatment by DMARDs, some promising results have been obtained using anti-TNFα therapy, although results are equivocal. The aim of the current study was to summarise the existing evidence regarding the effectiveness of anti-TNFα agents in ACU. A systematic search of articles was conducted up to June 2012. Eligible studies investigated the efficacy of anti-TNFα therapy as the first biologic modifier immunosuppressant treatment for ACU, refractory to therapy with topical treatment and/or systemic treatment and at least one immunosuppressive treatment, among children (≤16 years). The primary outcome was the proportion of patients with improved intraocular inflammation. Treatment response between groups was compared using chi square tests. Of 959 articles identified, 25 retrospective chart reviews and one trial were eligible, comprising 245 children, 64% of whom had been treated with infliximab (INF), 25% etanercept (ETA) and 11%adalimumab (ADA). Pooled analysis revealed that a high proportion of patients responded positively to ADA and INF. In contrast, only a minority responded to ETA (see Table). Both INF and ADA showed superior efficacy compared to ETA (both p < 0.001), although there was no difference in the proportion of responders between ADA and INF (p = 0.14). Although RCTs are needed, current evidence does not support the use of ETA in the treatment of childhood ACU. Instead, we recommend the use of ADA or INF.
Original languageEnglish
Pages (from-to)E31-E31
Number of pages1
JournalScottish Medical Journal
Volume60
Issue number3
Publication statusPublished - Aug 2015

Cite this

@article{2396e32bb560402cbc92d5e729dd6b0e,
title = "Current evidence of anti-TNF alpha treatment efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach comparing the different drugs",
abstract = "Childhood autoimmune chronic uveitis (ACU) is associated with serious long-term complications including blindness. In ACU refractory to treatment by DMARDs, some promising results have been obtained using anti-TNFα therapy, although results are equivocal. The aim of the current study was to summarise the existing evidence regarding the effectiveness of anti-TNFα agents in ACU. A systematic search of articles was conducted up to June 2012. Eligible studies investigated the efficacy of anti-TNFα therapy as the first biologic modifier immunosuppressant treatment for ACU, refractory to therapy with topical treatment and/or systemic treatment and at least one immunosuppressive treatment, among children (≤16 years). The primary outcome was the proportion of patients with improved intraocular inflammation. Treatment response between groups was compared using chi square tests. Of 959 articles identified, 25 retrospective chart reviews and one trial were eligible, comprising 245 children, 64{\%} of whom had been treated with infliximab (INF), 25{\%} etanercept (ETA) and 11{\%}adalimumab (ADA). Pooled analysis revealed that a high proportion of patients responded positively to ADA and INF. In contrast, only a minority responded to ETA (see Table). Both INF and ADA showed superior efficacy compared to ETA (both p < 0.001), although there was no difference in the proportion of responders between ADA and INF (p = 0.14). Although RCTs are needed, current evidence does not support the use of ETA in the treatment of childhood ACU. Instead, we recommend the use of ADA or INF.",
author = "K. Druce and G. Simonini and R. Cimaz and Macfarlane, {G. J.} and Jones, {G. T.}",
year = "2015",
month = "8",
language = "English",
volume = "60",
pages = "E31--E31",
journal = "Scottish Medical Journal",
issn = "0036-9330",
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TY - JOUR

T1 - Current evidence of anti-TNF alpha treatment efficacy in childhood chronic uveitis

T2 - a systematic review and meta-analysis approach comparing the different drugs

AU - Druce, K.

AU - Simonini, G.

AU - Cimaz, R.

AU - Macfarlane, G. J.

AU - Jones, G. T.

PY - 2015/8

Y1 - 2015/8

N2 - Childhood autoimmune chronic uveitis (ACU) is associated with serious long-term complications including blindness. In ACU refractory to treatment by DMARDs, some promising results have been obtained using anti-TNFα therapy, although results are equivocal. The aim of the current study was to summarise the existing evidence regarding the effectiveness of anti-TNFα agents in ACU. A systematic search of articles was conducted up to June 2012. Eligible studies investigated the efficacy of anti-TNFα therapy as the first biologic modifier immunosuppressant treatment for ACU, refractory to therapy with topical treatment and/or systemic treatment and at least one immunosuppressive treatment, among children (≤16 years). The primary outcome was the proportion of patients with improved intraocular inflammation. Treatment response between groups was compared using chi square tests. Of 959 articles identified, 25 retrospective chart reviews and one trial were eligible, comprising 245 children, 64% of whom had been treated with infliximab (INF), 25% etanercept (ETA) and 11%adalimumab (ADA). Pooled analysis revealed that a high proportion of patients responded positively to ADA and INF. In contrast, only a minority responded to ETA (see Table). Both INF and ADA showed superior efficacy compared to ETA (both p < 0.001), although there was no difference in the proportion of responders between ADA and INF (p = 0.14). Although RCTs are needed, current evidence does not support the use of ETA in the treatment of childhood ACU. Instead, we recommend the use of ADA or INF.

AB - Childhood autoimmune chronic uveitis (ACU) is associated with serious long-term complications including blindness. In ACU refractory to treatment by DMARDs, some promising results have been obtained using anti-TNFα therapy, although results are equivocal. The aim of the current study was to summarise the existing evidence regarding the effectiveness of anti-TNFα agents in ACU. A systematic search of articles was conducted up to June 2012. Eligible studies investigated the efficacy of anti-TNFα therapy as the first biologic modifier immunosuppressant treatment for ACU, refractory to therapy with topical treatment and/or systemic treatment and at least one immunosuppressive treatment, among children (≤16 years). The primary outcome was the proportion of patients with improved intraocular inflammation. Treatment response between groups was compared using chi square tests. Of 959 articles identified, 25 retrospective chart reviews and one trial were eligible, comprising 245 children, 64% of whom had been treated with infliximab (INF), 25% etanercept (ETA) and 11%adalimumab (ADA). Pooled analysis revealed that a high proportion of patients responded positively to ADA and INF. In contrast, only a minority responded to ETA (see Table). Both INF and ADA showed superior efficacy compared to ETA (both p < 0.001), although there was no difference in the proportion of responders between ADA and INF (p = 0.14). Although RCTs are needed, current evidence does not support the use of ETA in the treatment of childhood ACU. Instead, we recommend the use of ADA or INF.

M3 - Abstract

VL - 60

SP - E31-E31

JO - Scottish Medical Journal

JF - Scottish Medical Journal

SN - 0036-9330

IS - 3

ER -