Does switching anti-TNF alpha biologic agents represent an effective option in childhood chronic uveitis: The evidence from a systematic review and meta-analysis approach

作者：Simonini Gabriele^*; Katie Druce; Cimaz Rolando; Macfarlane Gary J; Jones Gareth T

来源：Seminars in Arthritis and Rheumatism, 2014, 44(1): 39-46.

DOI：10.1016/j.semarthrit.2014.03.001

• Adalimumab
• Infliximab
• Etanercept
• Autoimmune chronic uveitis
• Childhood
• Refractory uveitis

Objective: To summarize the evidence regarding the effectiveness of switching to a second anti-TNF alpha treatment in children with autoimmune chronic uveitis (ACU), refractory to the first course of anti-TNF alpha treatment. %26lt;br%26gt;Methods: We conducted a systematic literature review between January 2000 and May 2013 to investigate the efficacy of a second anti-TNF alpha agent in the treatment of ACU in children (%26lt;= 16 years) refractory to a first course of a single anti-TNF alpha 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. %26lt;br%26gt;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. %26lt;br%26gt;Conclusions: Despite the fact that no RCT is available and the number of cases is

• 出版日期2014-8