Background/Purpose: To summarize evidence regarding efficacy of anti-tumour necrosis factor-α (anti-TNFα) in childhood autoimmune chronic uveitis (cACU), refractory to common disease modifying antirheumatic drugs (DMARDs).

Methods: An updated systematic search was conducted between November 2012 and January 2020. Studies investigating the efficacy of anti-TNFα therapy, in children ages < 16 years, as the first biologic treatment for cACU, refractory to topical and/or systemic steroid and at least one DMARD, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation according to Standardization of Uveitis Nomenclature Working Group criteria. A combined estimate of the proportion of children responding to etanercept (ETA), infliximab (INF), and adalimumab (ADA) was determined.

Results: We identified 1677 articles and 37 articles were eligible. Three were randomized clinical trials (RCTs), one on ETA and 2 on ADA, and were excluded from pooled analysis. From the observational studies, a total of 487 children were identified: 226 received ADA, 213 INF and 48 ETA. The proportion of responding children was 86% (95% CI 76–95%) for ADA, 68% (95% CI 50–85%) for INF, and 36% (95% CI 9–67%) for ETA.  Pooled analysis showed clear differences (χ2= 32.2, p< 0.0001): ADA and INF were both significantly superior to ETA (χ2 =26.8, p< 0.0001, and χ2= 7.41, p< 0.006 respectively), ADA significantly superior to INF (χ2= 13.4, p< 0.0002).

Conclusion: This metanalysis, consistent with recent RCT data, suggests the efficacy of ADA and INF in cACU treatment. However, ADA results superior to INF in this clinical setting.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/changing-evidence-over-time-updated-meta-analysis-regarding-anti-tnf-efficacy-in-childhood-chronic-uveitis/