Retrospective case review of pediatric patients with uveitis treated with infliximab.
OBJECTIVE
To assess the response and adverse events associated with infliximab treatment for refractory, noninfectious pediatric uveitis.


METHODS
Retrospective noncomparative case series of pediatric patients with refractory uveitis treated with infliximab.


METHODS
Six patients were identified. Diagnoses of the participants included idiopathic uveitis (n = 1), juvenile rheumatoid arthritis with uveitis (n = 3), idiopathic retinal vasculitis with uveitis (n = 1), and bilateral pars planitis, with vitreitis and papillitis of the left eye (n = 1). Uveitis developed in the patients (5 female, 1 male) at a mean age of 9.0 years (+/-5.0 years; range, 0.9-14.8 years). All patients had bilateral eye involvement. These patients were refractory to or dependent on topical steroids (n = 4), oral prednisone (n = 3), or both, and were also refractory to the following therapies: methotrexate (n = 6), cyclosporine (n = 3), mycophenolate mofetil (n = 3), etanercept (n = 3), and daclizumab (n = 1).


METHODS
All patients initially received infliximab at doses between 5 and 10 mg/kg at 2- to 4-week intervals, and then were maintained at 4- to 8-week intervals at doses of 5 to 18 mg/kg. Mean follow-up time on treatment has been 48.1 weeks (+/-14.9 weeks; range, 32-74 weeks).


METHODS
Primary outcome measures included the quantitative measurement of the amount of ocular inflammation in different locations within the eye. Patients were monitored for infusion reactions as well as other potential side effects. The children's clinical status, complete blood counts, and liver function panels were monitored by pediatric rheumatologists every 6 weeks.


RESULTS
All 6 patients showed reduction in their intraocular inflammation after infliximab therapy was initiated. Furthermore, control of ocular inflammation was achieved while receiving infliximab therapy. Topical and systemic corticosteroids were able to be discontinued in all patients except for 1 patient, who is currently weaning off prednisone. The only adverse reactions seen were the development of vitreous hemorrhage in 1 patient and a case of transient upper respiratory infusion reaction. No patient has had to discontinue treatment.


CONCLUSIONS
Infliximab seems to be an effective agent for the treatment of refractory pediatric uveitis without apparent serious toxicity in this series of patients.
Rajaraman
Ravindran T
RT
Joseph M. Sanzari's Children Hospital, Hackensack University Medical Center, Hackensack, New Jersey, USA.
Kimura
Yukiko
Y
Li
Suzanne
S
Haines
Kathleen
K
Chu
David S
DS
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy; D002648:Child; D005260:Female; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D012189:Retrospective Studies; D014605:Uveitis / Q000188:drug therapy* / Q000209:etiology; D014792:Visual Acuity
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab