Tumor necrosis factor-alpha blocker in treatment of juvenile idiopathic arthritis-associated uveitis refractory to second-line agents: results of a multinational survey.

T Objective. Uveitis occurs in l09i»l5% of patients with juvenile idiopathic arthritis (JIA). If topical treatment fails, second—Iine agents are used to control the dismse. However, some patients need the addition of tumor necrosis factor»ot (TNF»ot) 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 HA»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 t;reat~ ment 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 inflixirnab. The final response was rated according to a composite index as 53%/ 12%/32%, and according to physician rating as 47%/ l2%/38% representing good, moderate, and poor, respectively. in the etaneicept group; and 70%/30%/0% and 68%/24%/0% in the intliximab group. All 3 patients taking adaliniumab were responders. lntliximab was statistically significantly more efficacious for the treatment of HA-associated uveitis than etanercept (chi-square p = 0.004). Conclusion. Anti—TNF seems to be an effective treatment for refractory .llA—associated uveitis. In this cohort infliximab was more efficacious than etanercepr.