title: Tumor necrosis factor-alpha blocker in treatment of juvenile idiopathic arthritis-associated uveitis refractory to second-line agents: results of a multinational survey.
abstract: OBJECTIVE
  Uveitis occurs in 10%-15% of patients with juvenile idiopathic arthritis (JIA). If topical treatment fails, second-line agents are used to control the disease. However, some patients need the addition of tumor necrosis factor-alpha (TNF-alpha) antagonist (anti-TNF). We organized a cross-sectional cohort to investigate use and efficacy of anti-TNF treatment in patients with JIA-associated uveitis.
  
  
  METHODS
  The international pediatric rheumatology community was queried about the use and efficacy of anti-TNF in treatment of JIA-associated uveitis using an E-mail survey.
  
  
  RESULTS
  Of the 33 responding centers following 884 patients with uveitis, only 15 centers, following 404 patients, were using anti-TNF for this indication. A total of 47 patients with JIA-related uveitis treated with anti-TNF because of an insufficient response to previous therapy were reported. The mean age of the patients was 12.5 years. The mean duration from onset of uveitis to start of anti-TNF treatment was 45.1 months. Three different anti-TNF agents were used: etanercept in 34 cases, infliximab in 25 cases, and adalimumab in 3 cases. In 12 of the 34 patients etanercept was inefficacious and patients were switched to infliximab. The final response was rated according to a composite index as 53%/12%/32%, and according to physician rating as 47%/12%/38% representing good, moderate, and poor, respectively, in the etanercept group; and 70%/30%/0% and 68%/24%/0% in the infliximab group. All 3 patients taking adalimumab were responders. Infliximab was statistically significantly more efficacious for the treatment of JIA-associated uveitis than etanercept (chi-square p = 0.004).
  
  
  CONCLUSIONS
  Anti-TNF seems to be an effective treatment for refractory JIA-associated uveitis. In this cohort infliximab was more efficacious than etanercept.
authors.affiliation: Department of Pediatric Rheumatology, Hamburger Zentrum für Kinder und Jugendrheumatologie, Klinikum Eilbek, Hamburg, Germany. sprechstunde@kinderrheumatologie.de
authors.forename: Ivan
authors.initials: I
authors.lastname: Foeldvari
authors.forename: Susanne
authors.initials: S
authors.lastname: Nielsen
authors.forename: Jasmin
authors.initials: J
authors.lastname: Kümmerle-Deschner
authors.forename: Graciela
authors.initials: G
authors.lastname: Espada
authors.forename: Gerd
authors.initials: G
authors.lastname: Horneff
authors.forename: Blanca
authors.initials: B
authors.lastname: Bica
authors.forename: Alma N
authors.initials: AN
authors.lastname: Olivieri
authors.forename: Angela
authors.initials: A
authors.lastname: Wierk
authors.forename: Rotraud K
authors.initials: RK
authors.lastname: Saurenmann
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D000068800:Etanercept; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D007391:International Cooperation; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014605:Uveitis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept