1
|
Huard J, Mihailescu SD, Muraine M, Raymond S, Grall Lerosey M, Gueudry J. Effectiveness and Safety of Weekly Adalimumab for Non-Infectious Chronic Anterior Uveitis in Children. Ocul Immunol Inflamm 2023; 31:2039-2049. [PMID: 37972236 DOI: 10.1080/09273948.2023.2279682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Non-infectious chronic anterior uveitis (CAU) remains a therapeutic challenge. The purpose of this study was to analyze the effectiveness and safety of weekly dosing of adalimumab in children with non-infectious refractory CAU. Methods: Demographic and clinical data of children followed by non-infectious CAU treated with adalimumab were retrospectively reviewed. RESULTS Of the 42 children with CAU, 27/42 (64.3%) were treated with adalimumab. Escalation to weekly dosing of adalimumab was necessary for 11/27 children (40.7%). After 3 and 6 months, 7/11 children (63.6%) met the composite endpoint of inflammation control improvement. Children requiring weekly adalimumab had initially more severe uveitis: anterior chamber cells (p = 0.02), aqueous flare (p = 0.02), and presence of macular edema (p = 0.007). No children had serious systemic side effects. CONCLUSION Weekly adalimumab in children with refractory CAU appears to be an effective and safe treatment for inflammation control and corticosteroid sparing, and an alternative before biologic switching. Controlled studies are needed.
Collapse
Affiliation(s)
- Justine Huard
- Department of Ophthalmology, CHU ROUEN, Rouen, France
| | - Sorina-Dana Mihailescu
- Innovation, Clinical Research and Educational Unit (CIRCE), Eure-Seine Hospital, Evreux, France
| | - Marc Muraine
- Department of Ophthalmology, CHU ROUEN, Rouen, France
| | | | | | - Julie Gueudry
- Department of Ophthalmology, CHU ROUEN, Rouen, France
| |
Collapse
|
2
|
|
3
|
Ferrara G, Mastrangelo G, Barone P, La Torre F, Martino S, Pappagallo G, Ravelli A, Taddio A, Zulian F, Cimaz R. Methotrexate in juvenile idiopathic arthritis: advice and recommendations from the MARAJIA expert consensus meeting. Pediatr Rheumatol Online J 2018; 16:46. [PMID: 29996864 PMCID: PMC6042421 DOI: 10.1186/s12969-018-0255-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/08/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Conventional pharmacological therapies for the treatment of juvenile idiopathic arthritis (JIA) consist of non-biological, disease-modifying antirheumatic drugs, among which methotrexate (MTX) is the most commonly prescribed. However, there is a lack of consensus-based clinical and therapeutic recommendations for the use of MTX in the management of patients with JIA. Therefore, the Methotrexate Advice and RecommendAtions on Juvenile Idiopathic Arthritis (MARAJIA) Expert Meeting was convened to develop evidence-based recommendations for the use of MTX in the treatment of JIA. METHODS The preliminary executive committee identified a total of 9 key clinical issues according to the population, intervention, comparator, outcome (PICO) approach, and performed an evidence-based, systematic, literature review. During the subsequent Expert Meeting, the relevant evidence was assessed and graded, and 10 recommendations were made. RESULTS Recommendations relating to the efficacy, optimal dosing and route of administration and duration of treatment with MTX in JIA, and to the issue of folic acid supplementation to prevent MTX side effects, use of MTX in the treatment of chronic JIA-associated uveitis, combination treatment with biologic agents, and the use of vaccinations in patients with JIA were developed. The selected topics were considered to represent clinically important issues facing clinicians caring for patients with JIA. Evidence was insufficient to formulate recommendations for the use of biomarkers predictive of treatment response. CONCLUSIONS These consensus recommendations provide balanced and evidence-based recommendations designed to have broad value for physicians and healthcare clinicians involved in the clinical management of patients with JIA.
Collapse
Affiliation(s)
| | - Greta Mastrangelo
- Rheumatology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - Patrizia Barone
- Department of Pediatrics, University of Catania, Catania, Italy
| | - Francesco La Torre
- Pediatric Rheumatology Section, Pediatric Onco-Hematology Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Silvana Martino
- Clinica Pediatrica Università di Torino, Day-Hospital Immunoreumatologia, Turin, Italy
| | | | - Angelo Ravelli
- Pediatria II – Reumatologia, Istituto Giannina Gaslini, and Università degli Studi di Genova, Genoa, Italy
| | - Andrea Taddio
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, and University of Trieste, Trieste, Italy
| | - Francesco Zulian
- Department of Pediatrics, Rheumatology Unit, University of Padua, Padua, Italy
| | - Rolando Cimaz
- Rheumatology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - On behalf of the Rheumatology Italian Study Group
- University of Trieste, Trieste, Italy
- Rheumatology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
- Department of Pediatrics, University of Catania, Catania, Italy
- Pediatric Rheumatology Section, Pediatric Onco-Hematology Unit, Vito Fazzi Hospital, Lecce, Italy
- Clinica Pediatrica Università di Torino, Day-Hospital Immunoreumatologia, Turin, Italy
- Epidemiology & Clinical Trials Office, General Hospital, Mirano VE, Italy
- Pediatria II – Reumatologia, Istituto Giannina Gaslini, and Università degli Studi di Genova, Genoa, Italy
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, and University of Trieste, Trieste, Italy
- Department of Pediatrics, Rheumatology Unit, University of Padua, Padua, Italy
| |
Collapse
|
4
|
Abstract
Cryopyrin-associated periodic syndromes (CAPS) are linked to one single gene mutations, however they are associated with 3 syndromes, which are, from the mildest to the most severe phenotype familial cold urticaria, Muckle-Wells syndrome and chronic, infantile, neurologic, cutaneous, articular (CINCA) syndrome also called neonatal-onset multisystem inflammatory disease (NOMID). Autosomic dominant inheritance is present in most cases but in CINCA/NOMID syndrome where neomutations are more common. Mutations in the gene encoding cryopyrin, NLRP3, are associated with deregulation of caspase-1 activity, excessive interleukin-1 production and an autoinflammatory syndrome, which in familial cold urticaria and Muckle-Wells syndrome may be triggered or worsened by exposure to coldness. More and more mutations are described and even somatic mutations that can explain some clinical signs beginning in adulthood. Patients disclose a pseudo-urticarial rash, arthralgia, headaches, sometimes fever, biological inflammation but also, in severe forms of the disease, neurologic inflammation with central deafness, ophthalmologic inflammation, chronic meningitis. Some CINCA/NOMID patients also develop growth cartilage pseudo-tumoral hypertrophy. Natural disease history is usually benign in familial cold urticarial but severe in the other forms, particularly regarding neuro-sensorial involvement. In addition, secondary AA amyloidosis may develop in all forms in the absence of control of chronic inflammation. Anti-interleukin-1 treatment with anakinra, rilonacept or canakinumab induces in most cases complete remission, however sequelae may be present, particularly if central deafness or cartilage bone hypertrophy have already developed. This treatment is also important to prevent secondary amyloidosis or stabilize and even sometimes allow improvement of amyloidosis lesions.
Collapse
|
5
|
Hügle B, Horneff G. The role of synthetic drugs in the biologic era: therapeutic strategies for treating juvenile idiopathic arthritis. Expert Opin Pharmacother 2016; 17:703-14. [PMID: 26678914 DOI: 10.1517/14656566.2016.1133592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Juvenile idiopathic arthritis is the most frequent chronic rheumatic disease in childhood. Synthetic disease modifying drugs (DMARDs) have been used in its treatment since the 1980s and have led to substantial improvement of quality of life and disease outcome. Recent pharmacological research has focused on newer medications, especially biologic agents. AREAS COVERED Synthetic DMARDS, especially methotrexate, rightfully remain the first-line treatment of most categories of juvenile arthritis, as attested by several international guidelines. A substantial body of evidence supports these medications, and recent research tries to clarify their optimal use in the clinical setting, both as monotherapy and in combination with biologics. In addition, new forms of synthetic DMARDs are in the research pipeline, or are already used for rheumatoid arthritis. EXPERT OPINION Methotrexate remains the preferred first-line medication for polyarticular arthritis, with leflunomide as a viable alternative in case of intolerance or toxicity, despite lack of approval in Europe and the US. Sulfasalazine and hydroxychloroquine are used only rarely in clinical practice, considered in combination with methotrexate if biologics are not available. New synthetic DMARDS are in the research pipeline for JIA, in the form of small molecules.
Collapse
Affiliation(s)
- Boris Hügle
- a German Center for Pediatric Rheumatology , Garmisch-Partenkirchen , Germany
| | - Gerd Horneff
- b Department of Pediatrics , Asklepios Clinic Sankt Augustin , Sankt Augustin , Germany
| |
Collapse
|
6
|
El Maghraoui A. [Juvenile idiopathic arthritis]. Presse Med 2013; 43:27-33. [PMID: 23886930 DOI: 10.1016/j.lpm.2013.01.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 11/26/2022] Open
Abstract
Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age. This term encompasses several disease categories, each of which has distinct clinical signs and, in some cases, genetic background. The cause of disease is still poorly understood but seems to be related to both genetic and environmental factors. Prognosis has greatly improved as a result of substantial progresses in disease management. The most important new development has been the introduction of drugs such as anticytokine agents, which constitute a valuable treatment option for patients who are resistant to conventional antirheumatic agents. Further insights into the disease pathogenesis and treatment will be provided by the continuous advances in the understanding of the mechanisms connected to the immune response and inflammatory process, and by the development of more efficient new drugs.
Collapse
|
7
|
Allard L, Giniès JL, Champion G, Chevailler A, Subra JF. Auto-anticorps anticytoplasme des polynucléaires neutrophiles en pédiatrie : caractéristiques cliniques. Arch Pediatr 2013; 20:232-40. [DOI: 10.1016/j.arcped.2012.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 10/19/2012] [Accepted: 12/11/2012] [Indexed: 11/30/2022]
|
8
|
Klein A, Kaul I, Foeldvari I, Ganser G, Urban A, Horneff G. Efficacy and safety of oral and parenteral methotrexate therapy in children with juvenile idiopathic arthritis: an observational study with patients from the German Methotrexate Registry. Arthritis Care Res (Hoboken) 2012; 64:1349-56. [PMID: 22649024 DOI: 10.1002/acr.21697] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The German Methotrexate Registry has been collecting data concerning the efficacy and safety of methotrexate (MTX) treatment since 2005. The aim of this retrospective analysis is to compare oral and parenteral MTX treatment regarding efficacy and safety. METHODS Inclusion criteria were diagnosis of juvenile idiopathic arthritis, MTX treatment for at least 6 months, a consistent route of administration of MTX, and no previous or concomitant treatment with biologic agents. Efficacy was measured by the American College of Rheumatology (ACR) pediatric (Pedi) criteria. Primary outcome was efficacy defined as the number of patients reaching ACR Pedi 30 improvement criteria after 6 months of treatment. Secondary outcome criteria were the ACR Pedi 50 and Pedi 70 criteria at 6 and 12 months, respectively. Analyses were performed with the intent-to-treat population. RESULTS Of the 411 eligible patients, 259 (63%) received oral MTX and 152 (37%) received subcutaneous MTX. In both patient groups, a comparable weekly dose of MTX (0.4 mg/kg versus 0.42 mg/kg) was used, and a comparable number of patients received concomitant steroids. The primary outcome in both treatment groups was that a comparably high number of patients showed a clinical response according to the ACR Pedi 30 score after 6 months of treatment (73% versus 72%; P = 0.87). Twenty-two percent of patients with oral therapy and 27% with subcutaneous therapy had at least 1 documented adverse event. Discontinuation of treatment was observed in both groups with equal frequency, while significantly more patients with subcutaneous application discontinued MTX because of adverse events (11% versus 5%; P = 0.02). CONCLUSION In this retrospective analysis, parenteral MTX was not superior to oral administration regarding efficacy and tolerability.
Collapse
Affiliation(s)
- A Klein
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Nordrheinwestfalen, Germany.
| | | | | | | | | | | |
Collapse
|
9
|
Quartier P. [New treatments in pediatric rheumatology: effects, limits, and future developments]. Arch Pediatr 2011; 18:1218-23. [PMID: 21963076 DOI: 10.1016/j.arcped.2011.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/22/2011] [Accepted: 08/23/2011] [Indexed: 11/12/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases. International networks have enabled therapeutic trials of medications targeting tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, or T-cell costimulation (abatacept). JIA-associated chronic uveitis may require the use of biotherapies that remain experimental in JIA, such as monoclonal antibodies to TNF-alpha. Systemic-onset JIA (also called childhood-onset Still's disease) raises specific treatment challenges and may require treatment with IL-1 or IL-6 antagonists. Patients with JIA should be managed in specialized centers that have coordinated chains of care for the entire pediatric period and into adulthood. In addition, the use of recently introduced treatments in pediatric patients requires close monitoring for long-term side effects.
Collapse
Affiliation(s)
- P Quartier
- Unité d'immunologie-hématologie et rhumatologie pédiatriques, centre de référence national maladies rares « arthrites juvéniles », hôpital Necker-Enfants-Malades, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France.
| |
Collapse
|
10
|
Quartier P. Current treatments for juvenile idiopathic arthritis. Joint Bone Spine 2010; 77:511-6. [DOI: 10.1016/j.jbspin.2010.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2010] [Indexed: 10/18/2022]
|