Treatment outcomes of a Swiss non-infectious paediatric uveitis cohort: retrospective study over ten years.

IF 2.3 Q1 OPHTHALMOLOGY
Jeanne Martine Gunzinger, Seraina Palmer Sarott, Fabio Meier, Christian Böni, Alice Kitay, Brigitte Simonsz-Tóth, Christina Gerth-Kahlert
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Abstract

Introduction: Paediatric uveitis treatment recommendations suggest a step-up treatment approach starting with topical treatment, followed by antimetabolites and thereafter biologics. With this study, we are investigating the safety and efficacy of the current treatment approach in a large cohort.

Material and methods: Single center retrospective study. Patients with non-infectious uveitis under the age of 18 years at first presentation, between January 2012 and June 2022, were eligible for inclusion. Data extracted from the electronic health records included age at first presentation, sex, involved eye segment, visual acuity (VA), complications, associated systemic disease, treatments, and number of consultations. Cases were grouped according to their final treatment regime (topical only, methotrexate, TNF alpha inhibitor, other). VA outcome, treatment response, adverse events, and frequency of consultations were evaluated. The study was approved by the local ethics committee.

Results: 64 non-infectious paediatric uveitis cases were included. Age at first diagnosis ranged from 2 to 17 years, with a two-peak distribution, 52% were male. Anterior uveitis was the most common presentation, followed by intermediate uveitis, posterior uveitis, and panuveitis. Topical treatment achieved remission in 23%, anti-metabolites in 12%, and escalation to TNF alpha inhibitors in 30%. Alternative treatments or observation only were documented in 16% and 17%, respectively. Median duration from first presentation to the start of anti-metabolite or TNF alpha inhibitor were 115 days and 269 days, respectively. There was a median of eight consultations during the first year of follow up. Frequency of consultations during the first year increased with every treatment escalation. VA outcome did not differ between the different treatment groups.

Conclusion: The step-up treatment approach shows a safe profile in regards to VA outcome. Methotrexate presents a high rate of treatment failure and adverse effects. Adalimumab and infliximab are effective and safe. Timely treatment escalation might lower treatment burden for affected children, their families, and health care providers.

瑞士非感染性儿童葡萄膜炎队列的治疗结果:超过十年的回顾性研究。
儿科葡萄膜炎的治疗建议建议从局部治疗开始,然后是抗代谢药物,然后是生物制剂。在这项研究中,我们正在一个大队列中调查当前治疗方法的安全性和有效性。材料和方法:单中心回顾性研究。2012年1月至2022年6月期间首次出现的年龄在18岁以下的非感染性葡萄膜炎患者符合纳入条件。从电子健康记录中提取的数据包括首次就诊时的年龄、性别、受累的眼节、视力(VA)、并发症、相关的全身性疾病、治疗和咨询次数。病例根据最终治疗方案(仅外用、甲氨蝶呤、TNF α抑制剂、其他)进行分组。评估VA结果、治疗反应、不良事件和咨询频率。该研究得到了当地伦理委员会的批准。结果:64例儿童非传染性葡萄膜炎。初诊年龄2 ~ 17岁,呈双峰分布,52%为男性。最常见的是前葡萄膜炎,其次是中间葡萄膜炎、后葡萄膜炎和全葡萄膜炎。局部治疗达到缓解的23%,抗代谢物达到缓解的12%,升级为TNF α抑制剂的30%。替代治疗或观察分别占16%和17%。从首次出现到开始使用抗代谢物或TNF α抑制剂的中位持续时间分别为115天和269天。在随访的第一年,平均进行了8次咨询。第一年的咨询频率随着治疗的每一次升级而增加。不同治疗组之间的VA结果没有差异。结论:就VA的预后而言,强化治疗方法是安全的。甲氨蝶呤有很高的治疗失败率和不良反应。阿达木单抗和英夫利昔单抗有效且安全。及时增加治疗可能会降低受影响儿童、其家庭和卫生保健提供者的治疗负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
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