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Abstract：
OBJECTIVE: Pediatric uveitis is a rare but sight-threatening condition. Prompt and adequate treatment is crucial to preserve vision and avoid long-term complications. In cases that are resistant to corticosteroids and disease-modifying anti-rheumatic drugs (DMARDs), anti-tumor necrosis (anti-TNF) biologic agents are usually added. In this study, we report our experience with adalimumab (ADA) anti-TNF use in this group of patients.
METHODS: This is a retrospective observational study conducted in a tertiary pediatric uveitis clinic, in Manchester Royal Eye Hospital. All patients were pediatric patients (aged 2-18 years old) under follow-up during the period of six months. The patients\' data were analyzed according to the diagnosis, age of onset of uveitis, systemic medications used before and concomitantly with ADA, duration of uveitis before starting ADA, its effect, and time to notice the therapeutic effect in controlling inflammation. Finally, cases were reviewed for the development of anti-drug antibodies.
RESULTS: Forty-two patients were included in the study. Idiopathic uveitis was diagnosed in 47.6% of patients and 40.5% of patients were associated with juvenile idiopathic arthritis (JIA). Most (97.6%) of patients were using topical steroids before starting ADA and 95.2% continued using steroids after established ADA use, but systemic steroid use was reduced from 33.3% to 14.3%. The most common non-biologic DMARD used before ADA was methotrexate (MTX) (90.5%). One-third of the patients started ADA between 6 and 12 months after the diagnosis of uveitis, while this percentage dropped to 9.5% the year after diagnosis. Seventy-eight percent of patients acquired complete clinical control of inflammation on ADA use. Almost 78.6% of patients showed a full response in less than six months. In eight patients who were not controlled or were transiently controlled on ADA, three patients had positive anti-drug antibodies. In one patient, antidrug antibodies were identified after 12 years of ADA use, and in another, after 4 years.
CONCLUSIONS: Adalimumab is an effective, well-tolerated drug in children with uveitis refractory to non-biologic DMARD therapy. DMARDs were usually used alongside ADA in this cohort and few patients had confirmed ADA antibodies.
METHODS: This is a retrospective observational study conducted in a tertiary pediatric uveitis clinic, in Manchester Royal Eye Hospital. All patients were pediatric patients (aged 2-18 years old) under follow-up during the period of six months. The patients\' data were analyzed according to the diagnosis, age of onset of uveitis, systemic medications used before and concomitantly with ADA, duration of uveitis before starting ADA, its effect, and time to notice the therapeutic effect in controlling inflammation. Finally, cases were reviewed for the development of anti-drug antibodies.
RESULTS: Forty-two patients were included in the study. Idiopathic uveitis was diagnosed in 47.6% of patients and 40.5% of patients were associated with juvenile idiopathic arthritis (JIA). Most (97.6%) of patients were using topical steroids before starting ADA and 95.2% continued using steroids after established ADA use, but systemic steroid use was reduced from 33.3% to 14.3%. The most common non-biologic DMARD used before ADA was methotrexate (MTX) (90.5%). One-third of the patients started ADA between 6 and 12 months after the diagnosis of uveitis, while this percentage dropped to 9.5% the year after diagnosis. Seventy-eight percent of patients acquired complete clinical control of inflammation on ADA use. Almost 78.6% of patients showed a full response in less than six months. In eight patients who were not controlled or were transiently controlled on ADA, three patients had positive anti-drug antibodies. In one patient, antidrug antibodies were identified after 12 years of ADA use, and in another, after 4 years.
CONCLUSIONS: Adalimumab is an effective, well-tolerated drug in children with uveitis refractory to non-biologic DMARD therapy. DMARDs were usually used alongside ADA in this cohort and few patients had confirmed ADA antibodies.
摘要：
目的：小儿葡萄膜炎是一种罕见但有视力威胁的疾病。及时和适当的治疗对于保护视力和避免长期并发症至关重要。在对皮质类固醇和疾病缓解抗风湿药（DMARDs）耐药的情况下，通常添加抗肿瘤坏死(anti-TNF)生物制剂。在这项研究中,我们报告了我们在这组患者中使用阿达木单抗(ADA)抗TNF的经验.
方法：这是一项在三级儿科葡萄膜炎诊所进行的回顾性观察研究，曼彻斯特皇家眼科医院.所有患者均为儿科患者（2-18岁），随访6个月。根据诊断对患者数据进行分析，葡萄膜炎的发病年龄，在ADA之前和同时使用的全身药物，在开始ADA之前葡萄膜炎的持续时间，其效果,和时间来注意控制炎症的治疗效果。最后,我们回顾了这些病例抗药物抗体的发展.
结果：42名患者被纳入研究。47.6％的患者诊断为特发性葡萄膜炎，40.5％的患者与幼年特发性关节炎（JIA）有关。大多数（97.6％）的患者在开始ADA之前使用局部类固醇，95.2％的患者在确定使用ADA后继续使用类固醇，但全身性类固醇使用率从33.3%降至14.3%.在ADA之前使用的最常见的非生物DMARD是甲氨蝶呤（MTX）（90.5％）。三分之一的患者在葡萄膜炎诊断后6至12个月开始ADA，而这一比例在诊断后一年下降到9.5%。78%的患者通过使用ADA获得了炎症的完全临床控制。近78.6%的患者在不到六个月的时间内表现出完全反应。在8例未控制或暂时控制ADA的患者中，3例患者的抗药物抗体阳性.在一个病人中,抗药物抗体在使用ADA12年后鉴定，在另一个，四年后。
结论：阿达木单抗是一种有效的，非生物DMARD治疗难治性葡萄膜炎儿童的药物耐受性良好。DMARDs通常与ADA一起使用，很少有患者确认了ADA抗体。
方法：这是一项在三级儿科葡萄膜炎诊所进行的回顾性观察研究，曼彻斯特皇家眼科医院.所有患者均为儿科患者（2-18岁），随访6个月。根据诊断对患者数据进行分析，葡萄膜炎的发病年龄，在ADA之前和同时使用的全身药物，在开始ADA之前葡萄膜炎的持续时间，其效果,和时间来注意控制炎症的治疗效果。最后,我们回顾了这些病例抗药物抗体的发展.
结果：42名患者被纳入研究。47.6％的患者诊断为特发性葡萄膜炎，40.5％的患者与幼年特发性关节炎（JIA）有关。大多数（97.6％）的患者在开始ADA之前使用局部类固醇，95.2％的患者在确定使用ADA后继续使用类固醇，但全身性类固醇使用率从33.3%降至14.3%.在ADA之前使用的最常见的非生物DMARD是甲氨蝶呤（MTX）（90.5％）。三分之一的患者在葡萄膜炎诊断后6至12个月开始ADA，而这一比例在诊断后一年下降到9.5%。78%的患者通过使用ADA获得了炎症的完全临床控制。近78.6%的患者在不到六个月的时间内表现出完全反应。在8例未控制或暂时控制ADA的患者中，3例患者的抗药物抗体阳性.在一个病人中,抗药物抗体在使用ADA12年后鉴定，在另一个，四年后。
结论：阿达木单抗是一种有效的，非生物DMARD治疗难治性葡萄膜炎儿童的药物耐受性良好。DMARDs通常与ADA一起使用，很少有患者确认了ADA抗体。
