Does switching anti-TNFα biologic agents represent an effective option in childhood chronic uveitis : the evidence from a systematic review and meta-analysis approach

To summarize the evidence regarding the effectiveness of switching to a second anti-TNF\u3b1 treatment in children with autoimmune chronic uveitis (ACU), refractory to the first course of anti-TNF\u3b1 treatment.We conducted a systematic literature review between January 2000 and May 2013 to investigate the efficacy of a second anti-TNF\u3b1 agent in the treatment of ACU in children ( 6416 years) refractory to a first course of a single anti-TNF\u3b1 treatment, topical and/or systemic steroid therapy and at least one DMARD. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria, at 6 (\ub12) months of treatment.Among 1086 identified articles, 128 were scrutinized: 10 observational studies, 6 on adalimumab (ADA), 3 on infliximab (INF), and 1 on both, were deemed eligible. Study cohort included 40 children (ADA = 34 and INF = 6), median age 8 years (range 3-16). Nine were males, 28 females (gender not reported in 3), 39/40 were affected by JIA. Seventeen children received etanercept: 11 were switched to ADA, the remaining 6 to INF. All 23 children who previously received INF were switched to ADA. Altogether, 30 children (24 on ADA, 6 on INF) of 40 responded to treatment: 0.75 (95% CI: 0.51-100) was the combined estimate of the proportion of subjects improving.Despite the fact that no RCT is available and the number of cases is small, this review provides evidence that switching to a second anti-TNF\u3b1 agent results in improvement of ocular activity for the 75% treated children