Changing biological disease modifying treatment for paediatric uveitis in the real world. (27th March 2019)

• Record Type: Journal Article
• Authors: Oh, Lawrence J.; Nguyen, Chu L.; Phan, Kevin; Wong, Eugene; Zagora, Sophia; Singh‐Grewal, Davinder; Chaitow, Jeffrey; Grigg, John R.; McCluskey, Peter
• Is Part Of: Clinical & experimental ophthalmology. Volume 47:Number 6(2019)
• Page Start: 741
• Page End: 748
• Publication Date: 2019-03-27
• Subjects: juvenile idiopathic arthritis‐associated uveitis -- paediatric uveitis -- biological agent -- disease modifying anti‐rheumatic drug; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1111/ceo.13494
• Languages: English
• ISSNs: 1442-6404

Abstract

Abstract: Importance: Paediatric uveitis is a severe sight‐threatening uveitis due to disease progression and treatment failure. Biological agents are a promising new treatment. This study provides real‐world data on their use from Sydney, Australia. Background: Traditionally corticosteroids and non‐biological immunosuppressive agents were used to treat paediatric uveitis, often with poor outcomes. Design: Retrospective, chart review over an 8‐year period at a tertiary referral eye hospital. Participants: A total of 27 paediatric uveitis patients treated with biological agents. Methods: Chart review of demographic data and treatment outcomes. Main Outcome Measures: Treatment efficacy (corticosteroid‐sparing effect, topical steroid cessation/reduction, reduction in systemic‐steroid sparing agents, change in intraocular inflammation, visual acuity and central macular thickness); treatment failure; and adverse events. Data were collected at biological initiation, 6 weeks, 6 months and 12 months. Results: Biological therapy over 1 year was effective with prednisolone dose reduced to <5 mg/day in five of six patients (83%), number of systemic steroid‐sparing agents was reduced to ≤1 in two of four patients (50%) and cessation of topical steroid achieved in 12/41 of eyes (29%). Improvement of anterior chamber cells by two grades occurred in 20/25 eyes (80%), improvement of logMAR to ≤0.3 occurred in 12/18 eyes (67%) and macular oedema decreased in 4/5 eyes (80%). Treatment failure occurred in six eyes (13.01%) and five patients (18.5%) developed an adverse reaction. Conclusions and Relevance: Biological therapy was effective in paediatric patients with uveitis. Intraocular inflammation improved with maintained visual acuity, systemic corticosteroid dose decreased and there was a low frequency of adverse events.