Hamburger Zentrum für Kinder- und Jugendrheumatologie, Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence An der Schön Klinik Hamburg Eilbek, Hamburg, Germany.
Teaching Unit of the Asklepios Campus of the Semmelweis Medical School, Budapest, Hungary.
Expert Rev Clin Immunol. 2024 Mar;20(3):267-276. doi: 10.1080/1744666X.2023.2284845. Epub 2023 Nov 28.
The management of refractory juvenile idiopathic associated uveitis (JIAU) or childhood-onset chronic anterior uveitis (CAU) is a challenge. There is no clear consensus or evidence base for to suggest the most appropriate therapy after primary or secondary failure of biweekly adalimumab. In this scenario, most clinicians advocate switching to another anti-tumor necrosis factor alpha inhibitor; however, there are a variety of other disease modifying agents to choose from albeit with a differing levels of evidence.
We discuss how to define nonresponse and potential treatment options for patients with JIAU and CAU refractory to biweekly adalimumab.
Uncontrolled CAU and JIAU remain one of the most challenging diseases to manage and can lead to irreversible loss of vision in a third of those affected. Amongst the possible choices, weekly adalimumab, infliximab, tocilizumab and abatacept have more evidence to support their use. JAK inhibitors seem to be a promising option. Golimumab and Rituximab has also been thought to be partially effective in some refractory cases, whereas IL-17, IL-23, and IL-12 inhibition along with apremilast seem not to be a therapeutic option currently. The route of administration should also be considered as there can be significant pros and cons for different children.
难治性青少年特发性相关葡萄膜炎（JIAU）或儿童发病的慢性前葡萄膜炎（CAU）的治疗具有挑战性。在阿达木单抗初次或二次治疗失败后，哪种治疗方法最合适目前尚无明确共识或循证医学依据。在这种情况下，大多数临床医生主张改用另一种抗肿瘤坏死因子-α抑制剂；然而，尽管有不同程度的证据，但还有许多其他的疾病修饰剂可供选择。
我们讨论了如何定义对阿达木单抗治疗无应答的 JIAU 和 CAU 患者，并探讨了潜在的治疗选择。
未得到控制的 CAU 和 JIAU 仍然是最难治疗的疾病之一，三分之一的患者会因此导致视力不可逆转的丧失。在可能的选择中，每周阿达木单抗、英夫利昔单抗、托珠单抗和阿巴西普的使用依据更充分。JAK 抑制剂似乎是一种很有前途的选择。在一些难治性病例中，戈利木单抗和利妥昔单抗也被认为部分有效，而 IL-17、IL-23 和 IL-12 抑制以及阿普司特目前似乎不是一种治疗选择。给药途径也应考虑在内，因为不同的孩子可能有明显的利弊。
