Changing evidence over time: updated meta-analysis regarding anti-TNF efficacy in childhood chronic uveitis

Abstract

Objective To summarize evidence regarding efficacy of anti-TNFα in childhood chronic uveitis, refractory to common DMARDs. Methods An updated systematic search was conducted between November 2012 and January 2020. Studies investigating the efficacy of anti-TNFα therapy, in children of ages <16 years, as the first biologic treatment for childhood chronic uveitis, refractory to topical and/or systemic steroid and at least one DMARD were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation according to Standardization of Uveitis Nomenclature Working Group criteria. A combined estimate of the proportion of children responding to etanercept (ETA), infliximab (INF), and adalimumab (ADA) was determined. Results We identified 1677 articles of which 37 articles were eligible. Three were randomized controlled trials, one on ETA and two on ADA, and were excluded from pooled analysis. From the observational studies, a total of 487 children were identified: 226 received ADA, 213 INF and 48 ETA. The proportion of responding children was 86% (95% CI: 76%, 95%) for ADA, 68% (95% CI: 50%, 85%) for INF and 36% (95% CI: 9%, 67%) for ETA. Pooled analysis showed clear differences (χ2 = 32.2, P < 0.0001): ADA and INF were both significantly superior to ETA (χ2 = 26.8, P < 0.0001, and χ2 = 7.41, P < 0.006, respectively), ADA significantly superior to INF (χ2 = 13.4, P < 0.0002). Conclusion This meta-analysis, consistent with recent randomized controlled trial data, suggests the efficacy of ADA and INF in childhood chronic uveitis treatment. However, ADA results were superior to those of INF in this clinical setting.

Comparison of Infliximab with Adalimumab for the treatment of non- infectious uveitis: a systematic review and meta-analysis

“…Another reason may be that we have incorporated NIU children into this study. Children with NIU have a lower prevalence of severe complications[28], and have a higher respondence rate which was substantiated by two reviews [29,30].…”

Behavioural side effects of inhaled corticosteroids among children and adolescents with asthma

“…There is also data suggesting that the more severe asthma, the higher the risk of ADHD and this may also influence the emergence of behavioural changes seen after initiation of ICS in children with a higher genetic susceptibility for one or both disorders [ 12 , 32 ]. Anxiety disorder and depression may also be more common in children with asthma, especially in those with uncontrolled asthma symptoms [ 33 ]. In short, not all behavioural changes after initiation of ICS may be true ADEs.…”

Pediatric uveitis: Role of the pediatrician

“…Two systematic reviews identified that adalimumab is better at controlling intra-ocular inflammation in JIA-associated uveitis than infliximab ( 217 , 232 ). The data from the BiKeR JIA registry showed that there was a tendency for more occurrence of JIA-associated uveitis in the Etanercept group than in the biologic naïve group although the difference was not significant (1.9/100 PY vs. 1.4/100 PY, p = 0.09) ( 233 ).…”