Etanercept Therapy in Children With Treatment-Resistant Uveitis

Arthritis Rheum. 2001 Jun;44(6):1411-5. doi: 10.1002/1529-0131(200106)44:6<1411::AID-ART235>3.0.CO;2-O.

Abstract

Objective: To evaluate the safety and efficacy of the tumor necrosis factor fusion protein etanercept in children with treatment-resistant uveitis.

Methods: Ten children with chronic active uveitis (7 girls and 3 boys, mean age 7.5 years [range 3-12 years]) were enrolled in this prospective study. In 7 children, uveitis was associated with pauciarticular juvenile rheumatoid arthritis. Five children were antinuclear antibody positive. All patients had failed previous therapy with topical steroids and methotrexate and/or cyclosporine. All were treated with etanercept at a dosage of 0.4 mg/kg twice weekly for the first 3 months, and then, if eyes did not improve, with 25 mg twice weekly (mean 1.1 mg/kg) for at least 3 additional months.

Results: At the beginning of the trial, uveitis affected 18 eyes in the 10 children. Within 3 months, 10 of 16 affected eyes (63%; P = 0.017) showed a rapid decrease in anterior chamber cell density, including remission of uveitis in 4 eyes. In children with visual acuity of less than 20/25, 4 of 10 eyes (40%) improved. An exacerbation of uveitis during etanercept therapy occurred in only 1 child (1 of 14 eyes [7%]). Other ocular outcome parameters, such as intraocular pressure, synechia formation, and lens clarity, remained unchanged. Following a dosage increase to an average of 1.1 mg/kg after 3 months in 7 children, no further improvement was noted.

Conclusion: Our data suggest that etanercept injected subcutaneously twice a week has a beneficial effect on treatment-resistant chronic uveitis in children. Further controlled studies with etanercept in systemic or topical form are necessary to confirm its efficacy and optimal mode of administration.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Administration, Topical
  • Antirheumatic Agents / administration & dosage
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Juvenile / complications
  • Arthritis, Juvenile / drug therapy*
  • Child
  • Child, Preschool
  • Cyclosporine / therapeutic use
  • Etanercept
  • Female
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunoglobulin G / administration & dosage
  • Immunoglobulin G / therapeutic use*
  • Injections, Subcutaneous
  • Male
  • Methotrexate / therapeutic use
  • Receptors, Tumor Necrosis Factor / administration & dosage
  • Receptors, Tumor Necrosis Factor / therapeutic use*
  • Recombinant Proteins
  • Treatment Outcome
  • Uveitis, Anterior / drug therapy*
  • Uveitis, Anterior / etiology
  • Vision Disorders / drug therapy
  • Vision Disorders / etiology
  • Visual Acuity

Substances

  • Antirheumatic Agents
  • Glucocorticoids
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Recombinant Proteins
  • Cyclosporine
  • Etanercept
  • Methotrexate