Care of the Pediatric Uveitis Patient: Calgary's Multifaceted Management Model

Authors: Imaan Z. Kherani, Julia Farah, Rajinder Nirwan, Natalia Figueiredo, Anna Ells, Michael Fielden, R. Geoff Williams, Amin Kherani, Olga Ziozina.

Author Disclosure Block: I.Z. Kherani: None. J. Farah: None. R. Nirwan: None. N. Figueiredo: None. A. Ells: None. M. Fielden: None. R. Williams: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Bayer, Novartis, Roche. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Bayer, Novartis, Roche, Allergan and Chengdu Kanghong. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Name of for- profit or not-for-profit organization(s); ArticDX. A. Kherani: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Novartis, Roche, Bayer, Alcon (educational). Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Abbvie, Alcon, Bayer, B & L, Novartis. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Abbvie, Allergan, Alcon, Bayer, Novartis, La Rohce, Genetech, Ophthotec, Chengdu Kanghong Biotechnology, Regeneron-Investigator. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Name of for-profit or not-for-profit organization(s); MD Collaborate. O. Ziozina: Membership on advisory boards or speakers’ bureaus; Name of for-profit or
not-for-profit organization(s); AbbVie. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisory Board Member.

Abstract Body:

Purpose: To examine treatment choices, anatomic, and visual outcomes of refractory non-infectious pediatric uveitis patients managed with Humira (adalimumab) for a period of 6 months minimum.

Study Design: Multi-physician retrospective chart review.

Methods: A retrospective review of electronic health records at Calgary Retina Consultants from 2000 to present was performed and included all pediatric patients prescribed adalimumab for primarily ocular reasons.
Results: Eleven patients were identified of which five were male and six were female. The mean age was
9.45 years (range 6-15 years). Of the eleven patients, two acquired anterior uveitis, four had intermediate uveitis, one was diagnosed with posterior uveitis, and four had panuveitis. Concurrent autoimmune conditions included juvenile idiopathic/rheumatoid arthritis, psoriasis, vasculitis (Bechet’s), and chronic recurrent multifocal osteomyelitis. Average time to adalimumab initiation from ocular diagnosis was 620 days. Reasons for adalimumab initiation included inadequate control of ocular inflammation, steroid sparing, and DMARDs (disease-modifying antirheumatic drugs) intolerance or failure. A noticeable downward overall trend was noted in the anterior cell chamber count and vitreous haze in majority of patients. More importantly, 4/11 patients who were on oral steroid pre-adalimumab were successfully steroid spared (<10mg/day) after 2 years of biologic use, 8/11 weaned off steroid drops after adalimumab initiation, and 11/11 had no steroid injections post-adalimumab initiation.

Conclusions: Biologic therapy, and specifically adalimumab, is helpful in inflammatory eye disease; based on this small clinical sample, it appears to be a safe and effective treatment modality for pediatric uveitis patients.