Does switching anti-TNF alpha biologic agents represent an effective option in childhood chronic uveitis: The evidence from a systematic review and meta-analysis approach

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

*Corresponding author for this work

Research output: Contribution to journalLiterature reviewpeer-review

15 Citations (Scopus)


Objective: To summarize the evidence regarding the effectiveness of switching to a second anti-TNF alpha treatment in children with autoimmune chronic uveitis (ACU), refractory to the first course of anti-TNF alpha treatment.

Methods: We conducted a systematic literature review between January 2000 and May 2013 to investigate the efficacy of a second anti-TNF alpha agent in the treatment of ACU in children (

Results: Among 1086 identified articles, 128 were scrutinized: 10 observational studies, 6 on adalimumab (ADA), 3 on infliximab (INF), and 1 on both, were deemed eligible. Study cohort included 40 children (ADA = 34 and INF = 6), median age 8 years (range 3-16). Nine were males, 28 females (gender not reported in 3), 39/40 were affected by JIA Seventeen children received etanercept: 11 were switched to ADA, the remaining 6 to INF. All 23 children who previously received INF were switched to ADA. Altogether, 30 children (24 on ADA, 6 on INF) of 40 responded to treatment: 0.75 (95% CI: 0.51-100) was the combined estimate of the proportion of subjects improving.

Conclusions: Despite the fact that no RCT is available and the number of cases is small, this review provides evidence that switching to a second anti-TNF alpha agent results in improvement of ocular activity for the 75% treated children (C) 2014 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)39-46
Number of pages8
JournalSeminars in arthritis and rheumatism
Issue number1
Early online date6 Mar 2014
Publication statusPublished - Aug 2014


  • Adalimumab
  • Infliximab
  • Etanercept
  • Autoimmune chronic uveitis
  • Childhood
  • Refractory uveitis
  • Juvenile Idiopathic Arthritis
  • Efficacy
  • Children
  • Therapy
  • Safety

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