Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Pediatric
uveitis can be vision-threatening. Treatment typically consists of ocular
steroids, methotrexate, and anti-tumor necrosis factor (TNF) agents. Optimal
duration of treatment and risk of relapse after medication taper is not well
studied in children. Our aim is to describe the course of medication taper and
discontinuation in a pediatric uveitis cohort.
Methods: There were 107
children with uveitis – JIA-associated uveitis (JIAU), idiopathic uveitis,
HLA-B27 (+) uveitis, and other etiologies. Demographic and clinical data were
collected. We compared children who attained remission after medication
discontinuation to those who relapsed, using Wilcoxon rank-sum tests, Fisher’s
exact tests and Kaplan-Meier estimates.
Results: There were 28 (26%) children
in whom we attempted to taper medication. Of these, 15 had JIAU, and 13 had
other forms of uveitis (U). They were primarily female (82%), Caucasian (54%),
and had anterior location (63%), bilateral involvement (73%), and ocular complications
(72%), most commonly synechiae (57%), cataracts (54%) and macular edema (32%).
Medications
were discontinued in only 6 (21%) children (4 with U, and 2 with JIAU). Of
these, 5 were on methotrexate and 1 on infliximab. Median time from start of
taper to discontinuation was 7 months (0-18 months). Children remained
relapse-free for a median of 8 months (0 – 2.1 years).
Of 21 children
who failed medication taper, 17 relapsed during taper, 2 are completing taper, 2
restarted methotrexate while on anti-TNF therapy, and 1 was lost to follow up.
Comparing children with a recurrence of uveitis to those who achieved
remission, those who flared were younger at uveitis diagnosis (4.1 vs. 10.3
years, p = 0.033). There was clinical trend of relapse in Caucasians compared
to African Americans, (11/13 (85%) vs. 1/4, (25%) p = 0.053), those treated for
a shorter duration (1.4 [0.9 – 2.3] vs. 1.8 [1.7-7.2] years), p = 0.166) and those
with JIAU (12/17 (71%) vs. 5/17 (29%), p = 0.162). There were no significant
differences in gender, etiology, laterality, complications, anterior chamber cells,
visual acuity, or duration of uveitis before taper.
Kaplan-Meier
product-limit survival estimates showed that approximately 30% failed taper
within 4 months, 40% within 9 months, 50% within 10 months, and 60% within 1
year.
Conclusion: Only 21% of children
achieved drug-free remission, and 60% relapsed within a year of medication
taper. Older age at diagnosis may be associated with success of drug taper. Our
results suggest potential differences in likelihood of remission associated
with race, duration of treatment, and uveitis diagnosis. Further study of factors
associated with optimal treatment of pediatric uveitis leading to disease
remission are warranted.
|
Table 1. Comparison of Children with Uveitis who Relapsed During Medication Taper |
|||
|
|
No Relapse N = 6 |
Relapse N = 17 |
p -value |
|
Gender, female |
4 (66.7%) |
14 (82.4%) |
0.576 |
|
Race |
|
|
|
|
Caucasian |
2 (33.3%) |
11 (64.7%) |
0.341 |
|
African American |
3 (50%) |
1 (5.8%) |
0.040* |
|
Other |
1 (16.7%) |
5 (29.4%) |
1.00 |
|
Uveitis Diagnosis |
|
|
|
|
JIA-Associated Uveitis |
2 (33.3%) |
12 (70.6%) |
0.162 |
|
Other Forms of Uveitis |
4 (66.7%) |
5 (29.4%) |
|
|
Age at Uveitis Diagnosis |
10.3 (5.2 – 12.6) |
4.1 (2.9 – 6.8) |
0.033* |
|
Duration of Disease To Date, years, median (25th – 75th) |
6.5 (4.2 – 10.2) |
5.8 (3.7 – 7.6) |
0.654 |
|
Duration of Uveitis Before Taper, years, median (25th – 75th) |
5.1 (2.6 – 9.2) |
2.6 (1.1 – 4.7) |
0.100 |
|
Duration of Treatment Before Taper, years, median (25th – 75th) |
1.8 (1.7-1.2) |
1.4 (0.9-2.3) |
0.166 |
|
Location |
|
|
|
|
Anterior |
2 (40%) |
13 (76.5%) |
0.068 |
|
Intermediate |
1 (20%) |
— |
|
|
Posterior/Panuveitis |
1 (20%) |
— |
|
|
Unknown |
1 (20%) |
4 (23.5%) |
|
|
Bilateral Disease |
6 (100%) |
11 (73.3%) |
0.281 |
|
Complications |
4 (66.7%) |
11 (64.7%) |
1.00 |
|
Cataracts |
3 (50%) |
8 (47.1%) |
1.00 |
|
Glaucoma |
1 (16.7%) |
6 (35.3%) |
0.621 |
|
Synechiae |
3 (50%) |
9 (52.9%) |
1.00 |
|
Macular Edema |
1 (16.7%) |
5 (29.4%) |
0.646 |
|
Amblyopia |
1 (16.7%) |
2 (11.8%) |
1.00 |
|
Worst LogMAR Visual Acuity, median (25th – 75th) |
0.92 (0.69 – 1.39) |
1.25 (0.41 – 1.39) |
0.797 |
|
Highest Anterior Chamber Cell Grade, median (25th – 75th) |
2+ (1+-2+) |
2+ (1+-3+) |
0.601 |
|
*p-value <0.05 |
|||
To cite this abstract in AMA style:
Angeles-Han ST, McCracken C, Yeh S, Stryker D, Jenkins K, Tommasello S, Lambert SR, Drews-Botsch C, Prahalad S. Medication Taper and Risk of Relapse in Pediatric Uveitis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/medication-taper-and-risk-of-relapse-in-pediatric-uveitis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/medication-taper-and-risk-of-relapse-in-pediatric-uveitis/