Efficacy of Infliximab Treatment and Effect of Treatment Adherence on Disease Control in Children with Severe, Refractory Uveitis
Virginia A. Miraldi Utz; Sabrina Bulas; Sarah Lopper; Daniel J. Lovell; Sa Ting; Adam H. Kaufman
Cincinnati Children’s Hospital Medical Center; Cincinnati Eye Institute; University of Cincinnati Department of Ophthalmology
Introduction: To report the effect of infliximab (IFX) on uveitis disease control and the effect of adherence on treatment efficacy
Methods: Retrospective study of 27 children treated for uveitis between 12/30/2002 and 4/30/2016. Disease activity (active visits/year) 2 years prior to or from the onset of uveitis to IFX initiation until most recent visit on IFX was analyzed by a repeated measures logistic regression analysis. Control of ocular and/or joint disease and pre-/post-treatment topical corticosteroid and glaucoma medications were analyzed. Non-adherence was defined as deviance in corticosteroid use and prescribed infusion and follow-up frequency.
Results: Patients were treated with IFX for an average of 41.6+/-31.2 months. 63% had JIA, (77% anterior, 18.5% intermediate, 4% pan-uveitis). Prior to IFX, 14 patients failed adalimumab+/-MTX and 9 failed MTX monotherapy. IFX led to uveitis control in 88.9% and arthritis control in 75% (13/17). The odds ratio of having inactive disease after IFX was 4.1 (2.6, 6.4) compared to pre-treatment visits. Topical corticosteroids and glaucoma medications were statistically decreased (p=0.007 OD, p=0.003 OS and p=0.001 OD, p=0.028 OS respectively). Non-adherent patients had a 10.3 times greater odds of having disease activity than adherent patients (7.1, 15.0).
Discussion: IFX treatment led to improved uveitis and JIA control and reduced topical corticosteroid and glaucoma medication use. Non-adherence remains highly associated with the likelihood of persistent disease activity.
Conclusion: This study supports the use of IFX as primary and/or secondary TNF-alpha treatment. Interventions to improve patient adherence represent an integral step to achieving uveitis control and require further study.
References: Heiligenhaus, A., et al., Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis: a consensus effort from the multinational interdisciplinary working group for uveitis in childhood. Arthritis Care Res (Hoboken), 2012. 64(9): p. 1365-72.