Use of tumor necrosis factor inhibitors in uveitis.
OBJECTIVE
Use of tumor necrosis factor-alpha blocking agents to treat chronic pediatric uveitis is becoming recognized as an important therapeutic modality. This review summarizes the rationale for this use, highlighting new studies of these agents in pediatric uveitis.


RESULTS
The majority of patients with pediatric uveitis either have idiopathic uveitis or uveitis associated with juvenile idiopathic arthritis. Ophthalmologic morbidity among these children is common. Most studies evaluating tumor necrosis factor-alpha blockade in pediatric uveitis are retrospective case series, with attendant limitations that are inherent to any retrospective study. Study of uveitis has been hampered by lack of standardization of disease and outcome measures, which has been addressed by uveitis experts with publication of consensus measures. Data to date suggest that tumor necrosis factor-alpha blockade is efficacious in refractory uveitis. Agents with direct tumor necrosis factor-alpha membrane receptor binding activity may be the most efficacious. There remain many unanswered questions in the treatment of pediatric uveitis, including optimal dosing regimen and long-term efficacy.


CONCLUSIONS
Tumor necrosis factor-alpha blocking agents play an important role in the treatment of chronic pediatric uveitis. Prospective comparative studies are needed so that we may better understand this role.
Rabinovich
C Egla
CE
Division of Pediatric Rheumatology, Duke University Medical Center, Durham, North Carolina 27710, USA. rabin001@mc.duke.edu
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014605:Uveitis / Q000150:complications / Q000188:drug therapy*
D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D047888:Receptors, Tumor Necrosis Factor, Type I; D014409:Tumor Necrosis Factor-alpha