title: Superior efficacy of Adalimumab in treating childhood refractory chronic uveitis when used as first biologic modifier drug: Adalimumab as starting anti-TNF-α therapy in childhood chronic uveitis.
abstract: BACKGROUND
  Nonetheless biologic modifier therapies are available treatment strategies for sight-threatening uveitis in children, the lack of evidence from head-to-head randomized controlled studies limits our understanding of timing of therapy when to commence therapy, which agent to choose and how long to continue treatment, and, in case of failure, if switching to another anti-TNF-α strategy might be eventually an option. Our aim was to compare the efficacy of Adalimumab when used as first anti-TNFα therapy versus Adalimumab used after the failure of a previous anti-TNFα (Infliximab) in an open-label, comparative, multi-center, cohort study of childhood chronic uveitis.
  
  
  METHODS
  26 patients (14 F, 12 M; median age: 8.6 years) with refractory, non-infectious active uveitis were enrolled. Due to the refractory course of uveitis to previous DMARD treatment, Group 1 received Adalimumab (24 mg/sq mt, every 2 weeks), as first anti-TNFα choice; Group 2 received Adalimumab, as second anti-TNFα drug, due to the loss of efficacy of Infliximab, administered after a period of at least 1 year. Both groups received Adalimumab for at least 1 year of treatment. Primary outcome was, once remission was achieved, the time to a first relapse.
  
  
  RESULTS
  14 children (10 with JIA, 3 with idiopathic uveitis, 1 with Behçet's disease) were recruited in Group 1; 12 children (7 with JIA, 3 with idiopathic uveitis, 1 with early-onset sarcoidosis, 1 with Behçet's disease) in Group 2. Group 2 showed a lower probability to steroid discontinuation during the first 12 months of treatment (Mantel-Cox χ(2)4.12, p<0.04). In long-term follow-up, Group 1 had higher probability of uveitis remission during the time of treatment on Adalimumab (median ±SE: 18 ±1.1 vs 4 ±0.6 months, CI 95%: 15.6-27.5 vs 2.7-5.2, Mantel-Cox χ(2)10.12, p<0.002).
  
  
  CONCLUSIONS
  Even if limited to a relatively small group, our study suggests a better efficacy of Adalimumab when used as first anti-TNFα treatment in childhood chronic uveitis.
authors.affiliation: Department of Paediatrics, Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence, Viale Pieraccini, Firenze 24 50139, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Simonini
authors.affiliation: Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, University of Trieste, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Taddio
authors.affiliation: Pediatric Clinic, University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cattalini
authors.affiliation: Department of Pediatrics, Ophthalmology Unit, Anna Meyer Children's Hospital, University of Florence, Firenze, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caputo
authors.affiliation: Ophthalmology Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, University of Trieste, Trieste, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: de Libero
authors.affiliation: Ophthalmology Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, University of Trieste, Trieste, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Parentin
authors.affiliation: Department of Paediatrics, Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence, Viale Pieraccini, Firenze 24 50139, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pagnini
authors.affiliation: Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, University of Trieste, Trieste, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Lepore
authors.affiliation: Department of Paediatrics, Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence, Viale Pieraccini, Firenze 24 50139, Italy.
authors.forename: Rolando
authors.initials: R
authors.lastname: Cimaz
keywords: Adalimumab; Children; Chronic uveitis; Infliximab