Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA.
Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
Int Ophthalmol. 2024 Sep 10;44(1):376. doi: 10.1007/s10792-024-03289-1.
Evaluate the response to adalimumab (ADA) in pediatric chronic anterior uveitis (pCAU).
Retrospective chart review of pCAU patients treated with ADA. Outcomes evaluated included the proportion of patients achieving zero ocular inflammation and discontinuation of topical corticosteroids, visual outcomes, and incidence of uveitis recurrences after ≥ 12 months of prescribing ADA. Incidence and risk factors for developing anti-adalimumab antibodies (AAAs) were also evaluated.
Of 27 children aged 11 years, 16 (59%) were Caucasian and 6 (22%) African Americans. Thirteen (48%) patients had idiopathic pCAU, 12 (44%) had juvenile idiopathic arthritis (JIA) related pCAU, and 2 (7%) had tubulointerstitial nephritis and uveitis syndrome. At baseline, African American children had worse visual acuity (p = 0.026). At 1 year, 21 (78%) children achieved zero ocular inflammation (remission). Risk factors associated with non-remission were being African American (20% vs. 94%, p = 0.003) and experiencing ≥ 1 episode of uveitis recurrence (100% vs. 0%, p < 0.001). Six episodes of uveitis recurrence were documented in five children, four of whom were African American. Topical corticosteroids were discontinued in 83% of children, and visual acuity remained stable for 1 year. Twelve children were tested for AAAs due to arthritis or uveitis flare-ups, with five (42%) being positive. No significant factors were associated with the development of AAAs.
We found that ADA is effective in controlling inflammation, reducing the need for topical corticosteroids, and maintaining visual acuity in pCAU. There appears to be racial differences in African American children who had worse baseline disease and poorer outcomes. Studies are necessary to understand better and address these disparities.
评估阿达木单抗（ADA）治疗儿科慢性前葡萄膜炎（pCAU）的疗效。
回顾性分析接受 ADA 治疗的 pCAU 患儿的病历。评估的结局包括达到无眼部炎症和停用局部皮质类固醇的患者比例、视力结果以及 ADA 治疗后≥12 个月时葡萄膜炎复发的发生率。还评估了产生抗阿达木单抗抗体（AAAs）的发生率和危险因素。
27 名 11 岁的患儿中，16 名（59%）为白种人，6 名（22%）为非裔美国人。13 名（48%）患儿为特发性 pCAU，12 名（44%）为幼年特发性关节炎（JIA）相关 pCAU，2 名（7%）为 tubulointerstitial nephritis and uveitis syndrome。基线时，非裔美国患儿的视力较差（p=0.026）。1 年后，21 名（78%）患儿达到无眼部炎症（缓解）。与未缓解相关的危险因素为非裔美国人（20% vs. 94%，p=0.003）和经历≥1 次葡萄膜炎复发（100% vs. 0%，p<0.001）。5 名患儿共发生 6 次葡萄膜炎复发，其中 4 名是非裔美国人。83%的患儿停用了局部皮质类固醇，且视力在 1 年内保持稳定。由于关节炎或葡萄膜炎发作，12 名患儿检测了 AAAs，其中 5 名（42%）呈阳性。未发现与产生 AAAs 相关的显著因素。
我们发现 ADA 可有效控制炎症，减少对局部皮质类固醇的需求，并维持 pCAU 的视力。非裔美国患儿疾病基线更差，结局更差，表明存在种族差异。需要进行研究以更好地了解和解决这些差异。
