JUVENILE UVEITIS

Danielle Ledoux, of Boston Children’s Hospital in the US, presented the latest data on outcomes of juvenile idiopathic arthritis (JIA)-associated uveitis treatment with biological agents at a joint session of the 2nd WCPOS and 12th EURETINA Congress. She reviewed data gathered from patients with her co-authors Rebecca Hunter and Anne Marie Lobo seen between 2006 and 2011 at two academic hospitals in Boston: the Uveitis Department of the Massachusetts Eye & Ear Infirmary and the Paediatric Ophthalmology Department at Boston Children’s Hospital. Patients were followed for a minimum of six months. Sixty patients participated, of whom 30 underwent TNFα-inhibitor treatment and 30 did not. The two groups were statistically identical in terms of median age at presentation of systemic disease; median age at presentation of uveitis; gender; ANA positivity; and median length of follow-up.

In line with other studies presented at this session, all patients who eventually underwent TNFα-inhibitors therapy had previously been treated with a wide range of medications. These included not only methotrexate (100 per cent), topical steroids (97 per cent), non-steroidals (67 per cent) and oral steroids (50 per cent), but also mycophenolate mofetil (22 per cent), leflunomide (19 per cent), non-TNF biologicals (nine per cent), azathioprine (three per cent) and cyclosporine (three per cent). Once treated with TNFα-inhibitors, all three main drugs were used: infliximab (40 per cent); adalimumab (35 per cent); and etanercept (15 per cent). The remaining 10 per cent received “other†TNFα-inhibitors. Visual outcomes in patients on TNFα- inhibitors was encouraging: 82 per cent of patients achieved vision better than or equal to 20/40, while only a minority suffered vision between 20/50 and 20/150 (13 per cent), or worse than 20/200 (five per cent). On the other hand, ocular complications were clearly more common in those eyes treated with TNFα-inhibitors. These included cataract, posterior synechiae, cystoid macular oedema, glaucoma or ocular hypertension and band keratopathy. Because this was a retrospective study, this might be explained by the fact that there was a selection bias for TNFα-inhibitor therapy, with this treatment modality being reserved for those patients with more severe disease, Dr Ledoux noted.