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.
- Autoimmune chronic uveitis
- Refractory uveitis
- Juvenile Idiopathic Arthritis