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.
|Number of pages||1|
|Journal||Scottish Medical Journal|
|Publication status||Published - Aug 2015|