Non-Infectious Chronic Uveitis in Childhood: Assessment and Treatment in the Biological Era
- PDF / 575,599 Bytes
- 17 Pages / 595.276 x 790.866 pts Page_size
- 40 Downloads / 149 Views
Pediatric Rheumatology (G Martini, Section Editor)
Non-Infectious Chronic Uveitis in Childhood: Assessment and Treatment in the Biological Era Roberta Ponti1 Maria Vincenza Mastrolia2 Gabriele Simonini3,* Address 1 Pediatric Residency, University of Udine, Via delle Scienze, 206, 33100, Udine, UD, Italy 2 Rheumatology Unit, Pediatric Residency, Anna Meyer Children’s University Hospital, University of Florence, 50121, Florence, FI, Italy *,3 Rheumatology Unit, NEUROFARBA Department, Anna-Meyer Children’s University Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy Email: [email protected]
* Springer Nature Switzerland AG 2020
Roberta Ponti and Maria Vincenza Mastrolia contributed equally to this work. This article is part of the Topical Collection on Pediatric Rheumatology Keywords Chronic uveitis I Non-infectious uveitis I Children I Therapy I Biologic drugs I Eye inflammation
Abstract Purpose of review Report of currently available medical strategies for treatment of childhood chronic uveitis in the biologic era. Recent Findings The management of non-infectious chronic uveitis in children is based on immunomodulatory treatment. In case of failure to conventional disease-modifying antirheumatic drugs (cDMARDs) and/or frequent flares, tumor necrosis factor-alpha (TNF-α) blocking agents represent the first biologic choice. Adalimumab is the TNF-α inhibitor more frequently adopted. Two multicenter, double blind, randomized, placebo-controlled trials stated its efficacy and safety in this clinical setting. For refractory disease not responsive to TNF-α inhibitors, emerging biologic therapies have been reported. Most of the current literature refers to expert opinion and remains non-standardized. However, retrospective studies and short case series report tocilizumab, abatacept, and rituximab as promising biologic alternatives in patients with refractory, sight-threatening uveitis even in children.
Pediatric Rheumatology (G Martini, Section Editor) Summary The role of anti-TNF-α inhibitor in chronic uveitis therapy met unanimous level of agreement. Rescue therapy approach still remains controversial. Randomized controlled trials and large series with long-term follow-up are mandatory to assess efficacy and cost effectiveness in this challenging disease. Trial registration ClinicalTrials.gov ID: NCT01279954. ClinicalTrials.gov ID: NCT04088409
Introduction Uveitis is an inflammatory disorder involving the uveal tract. [1]. In children, non-infectious, chronic uveitis is a relatively uncommon but serious disease, with the potential for significant complications and blindness. Ocular inflammation can be associated with an underlying systemic condition or not related to an identifiable origin; in this case, it is termed idiopathic. Juvenile idiopathic arthritis (JIA) is the most commonly associated disease, and uveitis is typically anterior and bilateral [1]. Compared to adults, childhood uveitis is characterized by poor prognosis and higher risk of secondary complications
Data Loading...
