Current evidence of anti-tumor necrosis factor α treatment efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach of individual drugs

Gabriele Simonini*, Katie Druce, Rolando Cimaz, Gary J. Macfarlane, Gareth T. Jones

*Corresponding author for this work

Research output: Contribution to journalArticle

58 Citations (Scopus)


OBJECTIVE: To summarize evidence regarding the effectiveness of anti-tumor necrosis factor α (anti-TNFα) treatments in childhood autoimmune chronic uveitis (ACU), refractory to previous disease-modifying antirheumatic drugs (DMARDs).

METHODS: A systematic search between January 2000 and October 2012 was conducted using EMBase, Ovid Medline, Evidence-Based Medicine (EBM) Reviews: American College of Physicians Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of anti-TNFα therapy, in children ages ≤16 years, as the first treatment with a biologic agent for ACU, refractory to topical and/or systemic steroid therapy and at least 1 DMARD, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the Standardization of Uveitis Nomenclature Working Group criteria. We determined a combined estimate of the proportion of children responding to anti-TNFα treatment, including etanercept (ETA), infliximab (INF), or adalimumab (ADA).

RESULTS: We initially identified 989 articles, of which 148 were potentially eligible. In total, 22 retrospective chart reviews and 1 randomized clinical trial were deemed eligible, thus including 229 children (ADA: n = 31, ETA: n = 54, and INF: n = 144). On pooled analysis of observational studies, the proportion of responding children was 87% (95% confidence interval [95% CI] 75-98%) for ADA, 72% (95% CI 64-79%) for INF, and 33% (95% CI 19-47%) for ETA. There was no difference in the proportion of responders between ADA and INF (χ(2) = 3.06, P = 0.08), although both showed superior efficacy compared with ETA (ADA versus ETA: χ(2) = 20.9, P < 0.001 and INF versus ETA: χ(2) = 20.9, P < 0.001).

CONCLUSION: Although randomized controlled trials are needed, the available evidence suggests that INF and ADA provide proven similar benefits in the treatment of childhood ACU, and they are both superior to ETA.

Original languageEnglish
Pages (from-to)1073-1084
Number of pages12
JournalArthritis Care & Research
Issue number7
Early online date26 Jun 2014
Publication statusPublished - Jul 2014



  • antirheumatic agents
  • child
  • chronic disease
  • humans
  • remission induction
  • retrospective studies
  • treatment failure
  • tumor necrosis factor-alpha
  • uveitis
  • visual acuity
  • juvenile idiopathic arthritis
  • refractory uveitis
  • infliximab therapy
  • Behcets-disease
  • ocular disease
  • case series
  • etanercept
  • adalimumbab
  • children
  • management

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