Methotrexate Experience in the Treatment of Pediatric Non-Infectious Uveitis: Is Monotherapy Enough?

Purpose: This study aimed to evaluate the efficacy of methotrexate (MTX) treatment in pediatric non-infectious uveitis (NIU) cases.

Methods: Patients diagnosed with pediatric NIU and initiated on subcutaneous MTX at a dose of 10 mg/m²/week between 2023 and 2025 were included in the study. The patients' age, age at uveitis diagnosis, anatomical localization and etiology of uveitis, baseline and final best-corrected visual acuity (BCVA), and anterior and posterior segment complications detected at the initial visit were recorded.

Results: A total of 127 eyes from 64 patients were included in the study. Of these patients, 39 were female, and 25 were male. The mean age was 9.89 ± 3.56 years (3-17 years). At the initial visit, at least one ocular complication in at least one eye was detected in 49 patients. Remission was achieved in 23 cases with MTX treatment, whereas 41 patients did not achieve remission. Among the 49 patients with at least one ocular complication, remission was achieved in 13 with MTX treatment. In contrast, among the 15 patients without any complications, remission was achieved in 10 (p = 0.005). The risk of non-responsiveness to MTX treatment was found to be 10.7 times higher in patients with at least one ocular complication at diagnosis.

Conclusion: MTX is an effective and safe treatment for pediatric NIU. However, in a significant proportion of patients, particularly those with ocular complications, MTX alone may be insufficient, necessitating the addition of other immunosuppressive agents.