Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: The current evidence from a systematic review

Gabriele Simonini, Rolando Cimaz, Gareth T Jones, Gary J Macfarlane

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE: To examine, separately, in children and adults with autoimmune chronic uveitis (ACU), the evidence regarding the effectiveness and the safety of switching to a non-anti-TNF biologic modifier immunosuppressant treatment (NTT) currently available in clinical practice.

METHODS: A systematic search between January 2000 and April 2014 was conducted using EMBASE, Ovid MEDLINE, Evidence Based Medicine Reviews-ACP Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of NTT as a biologic modifier immunosuppressant medication for ACU, refractory to topical and/or systemic steroid therapy, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria. We determined a combined estimate of the proportion of subjects responding to NTT.

RESULTS: We initially identified 526 articles, of which 89 were potentially eligible. From the selection process, a total of 10 retrospective chart reviews and a randomized single-blind controlled study, providing a total of 12 children and 34 adults, were deemed eligible: 3 articles looked at rituximab, 3 at abatacept, 3 at tocilizumab, and the remaining 1 at alemtuzumab and the other at anakinra. Before the NTT treatment, all the eligible subjects received several combinations of one or more DMARDs and at least one anti-TNF strategy. With the exclusion of 7 adults enrolled in the RCT, 8 of 12 children and 18 of 27 adults responded to NTT treatment: 0.66 was the combined estimate of the proportion of subjects improving on NTT treatment in children (95% CI: 0.46-0.99) and in adults (95% CI: 0.49-0.84). Further statistical comparison between different NTT strategies was not possible due to the small sample size.

CONCLUSION: Although randomized controlled trials are needed, the available evidence suggests the clinical use of a NTT strategy in selected categories of ACU, refractory to previous course of immunosuppressive treatment, DMARDs, as well as anti-TNFα, in adults as well as children.

Original languageEnglish
Pages (from-to)238-250
Number of pages13
JournalSeminars in arthritis and rheumatism
Volume45
Issue number2
Early online date21 May 2015
DOIs
Publication statusPublished - Oct 2015

Fingerprint

Uveitis
Immunosuppressive Agents
Pharmaceutical Preparations
Antirheumatic Agents
Therapeutics
Interleukin 1 Receptor Antagonist Protein
Single-Blind Method
Evidence-Based Medicine
MEDLINE
Sample Size
Libraries
Randomized Controlled Trials
Steroids
Outcome Assessment (Health Care)
Inflammation
Safety

Keywords

  • autoimmune chronic uveitis
  • alemtuzumab
  • anakinra
  • rituximab
  • abatacept
  • tocilizumab

Cite this

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title = "Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: The current evidence from a systematic review",
abstract = "OBJECTIVE: To examine, separately, in children and adults with autoimmune chronic uveitis (ACU), the evidence regarding the effectiveness and the safety of switching to a non-anti-TNF biologic modifier immunosuppressant treatment (NTT) currently available in clinical practice.METHODS: A systematic search between January 2000 and April 2014 was conducted using EMBASE, Ovid MEDLINE, Evidence Based Medicine Reviews-ACP Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of NTT as a biologic modifier immunosuppressant medication for ACU, refractory to topical and/or systemic steroid therapy, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria. We determined a combined estimate of the proportion of subjects responding to NTT.RESULTS: We initially identified 526 articles, of which 89 were potentially eligible. From the selection process, a total of 10 retrospective chart reviews and a randomized single-blind controlled study, providing a total of 12 children and 34 adults, were deemed eligible: 3 articles looked at rituximab, 3 at abatacept, 3 at tocilizumab, and the remaining 1 at alemtuzumab and the other at anakinra. Before the NTT treatment, all the eligible subjects received several combinations of one or more DMARDs and at least one anti-TNF strategy. With the exclusion of 7 adults enrolled in the RCT, 8 of 12 children and 18 of 27 adults responded to NTT treatment: 0.66 was the combined estimate of the proportion of subjects improving on NTT treatment in children (95{\%} CI: 0.46-0.99) and in adults (95{\%} CI: 0.49-0.84). Further statistical comparison between different NTT strategies was not possible due to the small sample size.CONCLUSION: Although randomized controlled trials are needed, the available evidence suggests the clinical use of a NTT strategy in selected categories of ACU, refractory to previous course of immunosuppressive treatment, DMARDs, as well as anti-TNFα, in adults as well as children.",
keywords = "autoimmune chronic uveitis, alemtuzumab, anakinra, rituximab, abatacept, tocilizumab",
author = "Gabriele Simonini and Rolando Cimaz and Jones, {Gareth T} and Macfarlane, {Gary J}",
note = "Copyright {\circledC} 2015 Elsevier Inc. All rights reserved.",
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language = "English",
volume = "45",
pages = "238--250",
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T1 - Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis

T2 - The current evidence from a systematic review

AU - Simonini, Gabriele

AU - Cimaz, Rolando

AU - Jones, Gareth T

AU - Macfarlane, Gary J

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2015/10

Y1 - 2015/10

N2 - OBJECTIVE: To examine, separately, in children and adults with autoimmune chronic uveitis (ACU), the evidence regarding the effectiveness and the safety of switching to a non-anti-TNF biologic modifier immunosuppressant treatment (NTT) currently available in clinical practice.METHODS: A systematic search between January 2000 and April 2014 was conducted using EMBASE, Ovid MEDLINE, Evidence Based Medicine Reviews-ACP Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of NTT as a biologic modifier immunosuppressant medication for ACU, refractory to topical and/or systemic steroid therapy, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria. We determined a combined estimate of the proportion of subjects responding to NTT.RESULTS: We initially identified 526 articles, of which 89 were potentially eligible. From the selection process, a total of 10 retrospective chart reviews and a randomized single-blind controlled study, providing a total of 12 children and 34 adults, were deemed eligible: 3 articles looked at rituximab, 3 at abatacept, 3 at tocilizumab, and the remaining 1 at alemtuzumab and the other at anakinra. Before the NTT treatment, all the eligible subjects received several combinations of one or more DMARDs and at least one anti-TNF strategy. With the exclusion of 7 adults enrolled in the RCT, 8 of 12 children and 18 of 27 adults responded to NTT treatment: 0.66 was the combined estimate of the proportion of subjects improving on NTT treatment in children (95% CI: 0.46-0.99) and in adults (95% CI: 0.49-0.84). Further statistical comparison between different NTT strategies was not possible due to the small sample size.CONCLUSION: Although randomized controlled trials are needed, the available evidence suggests the clinical use of a NTT strategy in selected categories of ACU, refractory to previous course of immunosuppressive treatment, DMARDs, as well as anti-TNFα, in adults as well as children.

AB - OBJECTIVE: To examine, separately, in children and adults with autoimmune chronic uveitis (ACU), the evidence regarding the effectiveness and the safety of switching to a non-anti-TNF biologic modifier immunosuppressant treatment (NTT) currently available in clinical practice.METHODS: A systematic search between January 2000 and April 2014 was conducted using EMBASE, Ovid MEDLINE, Evidence Based Medicine Reviews-ACP Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of NTT as a biologic modifier immunosuppressant medication for ACU, refractory to topical and/or systemic steroid therapy, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria. We determined a combined estimate of the proportion of subjects responding to NTT.RESULTS: We initially identified 526 articles, of which 89 were potentially eligible. From the selection process, a total of 10 retrospective chart reviews and a randomized single-blind controlled study, providing a total of 12 children and 34 adults, were deemed eligible: 3 articles looked at rituximab, 3 at abatacept, 3 at tocilizumab, and the remaining 1 at alemtuzumab and the other at anakinra. Before the NTT treatment, all the eligible subjects received several combinations of one or more DMARDs and at least one anti-TNF strategy. With the exclusion of 7 adults enrolled in the RCT, 8 of 12 children and 18 of 27 adults responded to NTT treatment: 0.66 was the combined estimate of the proportion of subjects improving on NTT treatment in children (95% CI: 0.46-0.99) and in adults (95% CI: 0.49-0.84). Further statistical comparison between different NTT strategies was not possible due to the small sample size.CONCLUSION: Although randomized controlled trials are needed, the available evidence suggests the clinical use of a NTT strategy in selected categories of ACU, refractory to previous course of immunosuppressive treatment, DMARDs, as well as anti-TNFα, in adults as well as children.

KW - autoimmune chronic uveitis

KW - alemtuzumab

KW - anakinra

KW - rituximab

KW - abatacept

KW - tocilizumab

U2 - 10.1016/j.semarthrit.2015.05.006

DO - 10.1016/j.semarthrit.2015.05.006

M3 - Article

C2 - 26164255

VL - 45

SP - 238

EP - 250

JO - Seminars in arthritis and rheumatism

JF - Seminars in arthritis and rheumatism

SN - 0049-0172

IS - 2

ER -