Tumor Necrosis Factor-a Blocker in Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to Second-line Agents: Results of a Multinational Survey
IVAN FOELDVARI, SUSANNE NIELSEN, JASMIN KÜMMERLE-DESCHNER, GRACIELA ESPADA, GERD HORNEFF, BLANCA BICA, ALMA N. OLIVIERI, ANGELA WIERK, and ROTRAUD K. SAURENMANN
Objective. Uveitis occurs in 10%–15% of patients with juvenile idiopathic arthritis (JIA). If topical treatment fails, second-line agents are used to control the disease. However, some patients need the addition of tumor necrosis factor-a (TNF-a) antagonist (anti-TNF). We organized a cross-sectional cohort to investigate use and efficacy of anti-TNF treatment in patients with JIA-associated uveitis.
Methods. The international pediatric rheumatology community was queried about the use and efficacy of anti-TNF in treatment of JIA-associated uveitis using an E-mail survey.
Results. Of the 33 responding centers following 884 patients with uveitis, only 15 centers, following 404 patients, were using anti-TNF for this indication. A total of 47 patients with JIA-related uveitis treated with anti-TNF because of an insufficient response to previous therapy were reported. The mean age of the patients was 12.5 years. The mean duration from onset of uveitis to start of anti-TNF treatment was 45.1 months. Three different anti-TNF agents were used: etanercept in 34 cases, infliximab in 25 cases, and adalimumab in 3 cases. In 12 of the 34 patients etanercept was inefficacious and patients were switched to infliximab. The final response was rated according to a composite index as 53%/12%/32%, and according to physician rating as 47%/12%/38% representing good, moderate, and poor, respectively, in the etanercept group; and 70%/30%/0% and 68%/24%/0% in the infliximab group. All 3 patients taking adalimumab were responders. Infliximab was statistically significantly more efficacious for the treatment of JIA-associated uveitis than etanercept (chi-square p = 0.004).
Conclusion. Anti-TNF seems to be an effective treatment for refractory JIA-associated uveitis. In this cohort infliximab was more efficacious than etanercept. (First Release Mar 1 2007; J Rheumatol 2007;34:1146–50)
Key Indexing Terms:
JUVENILE IDIOPATHIC ARTHRITIS
From the Department of Pediatric Rheumatology, Hamburger Zentrum für Kinder und Jugendrheumatologie, Klinikum Eilbek, Hamburg, Germany; Julinae Marie Centret, Righospitalet, Copenhagen, Denmark; Department of Pediatric Rheumatology, Universitätskinderklinik, Tübingen, Germany; Department of Pediatric Rheumatology, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina; Department of Pediatrics and Neonatology, Klinik Sankt Augustin, Sank Augustin, Germany; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Pediatrics, Seconda Universita di Napoli, Napoli, Italy; Pediatric Rheumatology Clinic, Allgemeinen Krankenhaus Eilbek, Hamburg, Germany; and University Children's Hospital Zürich, Zürich, Switzerland.
I. Foeldvari, MD, Head, Pediatric Rheumatology, Hamburger Zentrum für Kinder- und Jugendrheumatologie; S. Nielsen, MD, Associate Chief Doctor, Julinae Marie Centret, Righospitalet, Copenhagen; J. Kümmerle-Deschner, MD, Pediatric Rheumatology, Universitätskinderklinik, Tübingen; G. Espada, MD, Head, Pediatric Rheumatology, Children's Hospital Ricardo Gutierrez; G. Horneff, MD, Professor, Head, Pediatrics and Neonatology, Klinik Sankt Augustin; B. Bica, MD, Pediatric Rheumatologist, Federal University of Rio de Janeiro; A.N. Olivieri, MD, Department of Pediatrics, Seconda Universita di Napoli; A. Wierk, Study Nurse, Pediatric Rheumatology Clinic, Allgemeinen Krankenhaus Eilbek; R. K. Saurenmann, MD, Senior Consultant, University Children's Hospital Zürich.
Address reprint requests to Dr. I. Foeldvari, Department of Pediatric Rheumatology, Klinikum Eilbek, Dehnhaide 120, 22081 Hamburg, Germany. E-mail: firstname.lastname@example.org
Accepted for publication December 29, 2006.