Session Type: Abstract Submissions (ACR)
Background/Purpose: To summarize evidence regarding the effectiveness of anti-TNFα treatments in childhood autoimmune chronic uveitis (ACU), non responder and/or failure to previous DMARD course.Methods: A systematic search of articles between January 2000 and June 2012 was conducted using EMBASE, Ovid MEDLINE, Evidence Based Medicine Reviews–ACP Journal Club, Cochrane libraries, and EBM Reviews. Studies were eligible for inclusion if they investigated the efficacy of anti-TNFα therapy as the first biologic modifier immunosuppressant medication, among children (≤16 yrs) naïve to any anti-TNFα, therapy in the treatment of ACU, refractory to therapy with topical treatment and/or systemic treatment and at least one immunosuppressive treatment (MTX, and/or Azathioprin and/or CSA and/or Clorambucil and/or Micofenolate Mofetil). The primary outcome for this review was the proportion of patients classified as having improved intraocular inflammation, expressed as Tyndall, as defined by the Standardization of Uveitis Nomenclature (SUN) working group criteria. We determined a combined estimate of the proportion of children in the eligible studies responding to anti-TNFα treatment: Etanercept (ETA), Infliximab (INF), or Adalimumab (ADA).Results: The initial search identified 959 articles, of which 144 were potentially eligible. 26 eligible articles, all retrospective chart reviews, but one RCT, remained in the analysis. 245 children were included in the analysis (ADA n=27; ETA n=62 and INF n=156) and the number of children in studies ranged from 1 to 47. The pooled analysis suggested that INF and ADA have favorable effects in the improvement of intraocular inflammation: the proportion of responding subjects was 82% (95% CI: 68-96%) and 68% (61-76%) for ADA and INF respectively. In contrast, only 28% (16-40%) showed improvement with ETA. There was no difference in the proportion of responders between ADA and INF (χ2 2.17,p=0.14), although both showed superior efficacy compared to ETA (ADA vs ETA χ2 =21.1, p<0.001; INF vs ETA χ2=25.5, p<0.001) Conclusion: Although randomized controlled trials are needed, the available evidence does not support the use of ETA in the treatment of childhood ACU.; ADA and INF seem instead reliable approach for their treatment.
G. J. Macfarlane,
G. T. Jones,
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ACR Meeting Abstracts - http://acrabstracts.org/abstract/current-evidence-of-anti-tnf%ce%b1-treatment-efficacy-in-childhood-chronic-uveitis-a-systematic-review-and-meta-analysis-approach-comparing-the-different-drugs/