Abstract
Aims
Methotrexate (MTX) is standard treatment in pediatric chronic anterior uveitis (CAU). Addition of tumor necrosis factor-α inhibitors (TNFi) is often needed. We describe the timing and risk factors for TNFi use in children with CAU on MTX.
Methods
In this retrospective study, we reviewed 51 records, and 46 met inclusion criteria. Primary outcome was the addition of TNFi due to active CAU per Standardization of Uveitis Nomenclature criteria. Time to TNFi and factors associated with their addition were assessed using survival analysis models.
Results
Of 46 children treated with MTX for uveitis (36 juvenile idiopathic arthritis-associated uveitis, 10 idiopathic CAU), 72% had ocular complications. MTX was started a median of 5.0 months, and TNFi 43 months from uveitis diagnosis. Kaplan–Meier estimates suggest that cumulatively, 12% (95% CI: 4–23%) start TNFi within 6 months of MTX, 21% (12–37%) within 1 year, and 39% (24–54%) within 2 years. On Cox Proportional Hazard regression analysis, children with idiopathic CAU required TNFi earlier in their uveitis course (at 3 months (Hazard Ratio 6.06; 95% confidence interval (1.25–29.41))). Females appeared less likely to require TNFi early. Children treated in 2012 and later were more likely to receive TNFi earlier than those treated before 2012.
Conclusion
Little is known about optimal time to initiate treatment or factors associated with the need to add TNFi in children on MTX. Children with idiopathic CAU and males required TNFi earlier in their course. Factors associated with these potential risk factors for TNFi warrant further investigation.
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Acknowledgements
We thank Anna Tramposch and Bessie Frias for their assistance with data collection and data entry.
Funding
Dr. Angeles-Han is supported by Award Number K23EY021760 from the National Eye Institute, the Rheumatology Research Foundation, and the CCHMC Research Innovation and Pilot Fund. Dr. Prahalad is supported by The Marcus Foundation Inc. Atlanta GA.
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Dr. Steven Yeh is a consultant for Santen, Inc. and Clearside Biomedical. Dr. Sampath Prahalad is on an advisory committee for Novartis.
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McCracken, C., Yeh, S., Jenkins, K. et al. Timing of infliximab and adalimumab initiation despite methotrexate in children with chronic non-infectious anterior uveitis. Eye 33, 629–639 (2019). https://doi.org/10.1038/s41433-018-0283-0
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DOI: https://doi.org/10.1038/s41433-018-0283-0
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