Incidence and Predictors of Remission of Childhood Uveitis in a Large Community Cohort

Abstract

Purpose: To describe a large community cohort of incident cases of childhood uveitis and to determine incidence and predictors of remission.

Design: Retrospective clinical cohort study.

Methods: Participants were patients aged 16 years or younger who were newly diagnosed with uveitis at Kaiser Permanente Northern California, a large integrated health care system, between January 1, 2010, and December 31, 2020. Data were extracted electronically from medical records, pharmacy records, and health plan database. Incidence and predictors were determined using Cox regression modeling and survival analysis. The main outcome measure was the incidence of drug-free remission. For the primary analysis, remission was defined as no recurrence of active uveitis for at least 3 months beyond cessation of drug effect. Factors potentially predictive of remission were assessed.

Results: Of 1643 patients with incident uveitis, 277 incident cases of noninfectious uveitis were identified, including 145 patients (52.3%) with chronic noninfectious uveitis who were treated for at least 3 months; of these, 75 patients (51.7%) were female and 102 patients (70.3%) had anterior uveitis. Mean age at initial treatment was 9.8 (SD = 4.31) years. Mean follow-up time was 41.3 (SD = 31.8) months. At 5-year follow-up, the cumulative probability of drug-free remission was 50.8% (95% CI = 41.7%-60.6%). Age at start of treatment (adjusted hazard ratio [aHR] = 1.18. 95% CI = 1.1-1.28) and male sex (aHR = 1.85; 95% CI = 1.11-3.08) were associated with higher incidence of remission. Baseline characteristics that did not reach significance included bilateral disease, anterior uveitis, posterior synechiae, cataract, juvenile idiopathic arthritis, visual acuity, tobacco exposure, and socioeconomic status. A dose-response survival effect was seen with increasing age at presentation.

Conclusions: Almost half of the children with newly diagnosed chronic noninfectious uveitis achieved drug-free remission within 5 years of follow-up, with the youngest least likely to achieve remission and the oldest most likely to achieve remission. Female sex and younger age at presentation were independent predictors of lack of remission of childhood uveitis.