Does switching anti-TNFα biologic agents represent an effective option in childhood chronic uveitis: the evidence from a systematic review and meta-analysis approach.
OBJECTIVE
To summarize the evidence regarding the effectiveness of switching to a second anti-TNFα treatment in children with autoimmune chronic uveitis (ACU), refractory to the first course of anti-TNFα treatment.


METHODS
We conducted a systematic literature review between January 2000 and May 2013 to investigate the efficacy of a second anti-TNFα agent in the treatment of ACU in children (≤16 years) refractory to a first course of a single anti-TNFα treatment, topical and/or systemic steroid therapy and at least one DMARD. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria, at 6 (±2) months of treatment.


RESULTS
Among 1086 identified articles, 128 were scrutinized: 10 observational studies, 6 on adalimumab (ADA), 3 on infliximab (INF), and 1 on both, were deemed eligible. Study cohort included 40 children (ADA = 34 and INF = 6), median age 8 years (range 3-16). Nine were males, 28 females (gender not reported in 3), 39/40 were affected by JIA. Seventeen children received etanercept: 11 were switched to ADA, the remaining 6 to INF. All 23 children who previously received INF were switched to ADA. Altogether, 30 children (24 on ADA, 6 on INF) of 40 responded to treatment: 0.75 (95% CI: 0.51-100) was the combined estimate of the proportion of subjects improving.


CONCLUSIONS
Despite the fact that no RCT is available and the number of cases is small, this review provides evidence that switching to a second anti-TNFα agent results in improvement of ocular activity for the 75% treated children.
Rheumatology Unit, Department of Paediatrics, University of Florence, Anna Meyer׳s Children Hospital, viale Pieraccini #24, 50139 Firenze, Italy. Electronic address: gabriele.simonini@unifi.it.
Gabriele
G
Simonini
Musculoskeletal Research Programme-Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Druce
D
Katie
Rheumatology Unit, Department of Paediatrics, University of Florence, Anna Meyer׳s Children Hospital, viale Pieraccini #24, 50139 Firenze, Italy.
Rolando
R
Cimaz
Musculoskeletal Research Programme-Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Gary J
GJ
Macfarlane
Musculoskeletal Research Programme-Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Gareth T
GT
Jones
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use*; D057915:Drug Substitution; D006801:Humans; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014605:Uveitis / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
Adalimumab; Autoimmune chronic uveitis; Childhood; Etanercept; Infliximab; Refractory uveitis