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Mesa-Del-Castillo P, Yago Ugarte I, Bolarín JM, Martínez D, López Montesinos B, Barranco González H, Calvo Penadés I, Lacruz Pérez L, Clemente D, Robledillo JC, Valls Ferrán I, Bravo Mancheño B, Rubio Plats M, Martín Pedraz L, Alba Linero C, Sevilla-Pérez B, García-Serrano JL, Mir-Perelló MC, Druetta N, Souto A, Lopez-Lopez F, Zarallo-Reales C, Jerez Fidalgo M, Solana Fajardo J, Palmou Fontana N, Demetrio Pablo R, Pinedo MC, Fonollosa A, Jovani Casano V, Mondejar García JJ, Brandy A, García López A, Esteban-Ortega M, Reinoso T, Calzada-Hernández J, Llorca Cardeñosa A, Gavilán Martín C, Mengual Verdú E, Martínez Vidal MP, Quilis Martí N, Alvarado MC, De Inocencio J, Alonso-Martín B, Recuero-Diaz S, Carreño E, Nieto González JC, Ibares L, Rosas Gómez de Salazar J, Sánchez Sevila JL. Childhood-Onset Non-Infectious Uveitis in the "Biologic Era". Results From Spanish Multicenter Multidisciplinary Real-World Clinical Settings. Ocul Immunol Inflamm 2024:1-11. [PMID: 38728578 DOI: 10.1080/09273948.2024.2336609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/25/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To characterize and describe clinical experience with childhood-onset non-infectious uveitis. STUDY DESIGN A multicenter retrospective multidisciplinary national web-based registry of 507 patients from 21 hospitals was analyzed. Cases were grouped as immune disease-associated (IMDu), idiopathic (IDIu) or ophthalmologically distinct. Characteristics of juvenile idiopathic arthritis-associated (non-HLA-B27-related) uveitis (JIAu), IDIu, and pars planitis (PP) were compared. RESULTS IMDu (62.3%) and JIAu (51.9%) predominated in young females; and IDIu (22.7%) and PP (13.6%) in older children, without sex imbalance. Ocular complications occurred in 45.3% of cases (posterior synechiae [28%], cataracts [16%], band keratopathy [14%], ocular hypertension [11%] and cystoid macular edema [10%]) and were associated with synthetic (86%) and biologic (65%) disease-modifying antirheumatic drug (DMARD) use. Subgroups were significantly associated (p < 0.05) with different characteristics. JIAu was typically anterior (98%), insidious (75%), in ANA-positive (69%), young females (82%) with fewer complications (31%), better visual outcomes, and later use of uveitis-effective biologics. In contrast, IDIu was characteristically anterior (87%) or panuveitic (12.1%), with acute onset (60%) and more complications at onset (59%: synechiae [31%] and cataracts [9.6%]) and less DMARD use, while PP is intermediate, and was mostly bilateral (72.5%), persistent (86.5%) and chronic (86.8%), with more complications (70%; mainly posterior segment and cataracts at last visit), impaired visual acuity at onset, and greater systemic (81.2%), subtenon (29.1%) and intravitreal (10.1%) steroid use. CONCLUSION Prognosis of childhood uveitis has improved in the "biologic era," particularly in JIAu. Early referral and DMARD therapy may reduce steroid use and improve outcomes, especially in PP and IDIu.
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Affiliation(s)
- Pablo Mesa-Del-Castillo
- Department of Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Inés Yago Ugarte
- Department of Ophthalmology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - J M Bolarín
- Technological Centre of Information and Communication Technologies (CENTIC), Murcia, Spain
| | - David Martínez
- Department of Ophthalmology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | | | - Daniel Clemente
- Department of Pediatrics, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | | | - Isabel Valls Ferrán
- Department of Ophthalmology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | | | - Marina Rubio Plats
- Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Carmen Alba Linero
- Department of Ophthalmology, Hospital Universitario de Málaga, Málaga, Spain
| | - Belén Sevilla-Pérez
- Department of Pediatrics, Hospital Universitario San Cecilio, Granada, Spain
| | - J L García-Serrano
- Department of Ophthalmology, Hospital Universitario San Cecilio, Granada, Spain
| | | | - Noelia Druetta
- Department of Ophthalmology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Alex Souto
- Department of Rheumatology, Hospital Clinico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando Lopez-Lopez
- Department of Ophthalmology, Hospital Clinico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | | | - María Jerez Fidalgo
- Department of Ophthalmology, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - Jorge Solana Fajardo
- Department of Ophthalmology, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - Natalia Palmou Fontana
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rosalia Demetrio Pablo
- Department of Ophthalmology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Mari Carmen Pinedo
- Department of Pediatrics, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Vega Jovani Casano
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Anahy Brandy
- Department of Rheumatology, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Alba García López
- Department of Ophthalmology, Hospital Universitario de Cabueñes, Gijón, Spain
| | - M Esteban-Ortega
- Department of Ophthalmology, Hospital Infanta Sofía, Madrid, Spain
| | - Teresa Reinoso
- Department of Pediatrics, Hospital Infanta Sofía, Madrid, Spain
| | | | | | | | | | | | - Neus Quilis Martí
- Department of Rheumatology, Hospital Universitario Vinalopó, Elche, Spain
| | - M C Alvarado
- Department of Ophthalmology, Hospital Universitario Vinalopó, Elche, Spain
| | - Jaime De Inocencio
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Sheila Recuero-Diaz
- Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ester Carreño
- Department of Ophthalmology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Lucia Ibares
- Department of Ophthalmology, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Tegtmeyer K, Atassi G, Zhao J, Maloney NJ, Lio PA. Off-Label studies on anakinra in dermatology: a review. J DERMATOL TREAT 2020; 33:73-86. [PMID: 32279586 DOI: 10.1080/09546634.2020.1755417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose: Anakinra (Kineret®) is an interleukin-1 receptor antagonist (IL-1Ra) FDA approved for use in rheumatoid arthritis and in neonatal-onset multisystem inflammatory disease (NOMID). It has been used off-label for a variety of dermatologic conditions. A review of the available studies and cases of these off-label uses would be valuable to the dermatologist considering alternative treatments for these oftentimes poorly studied conditions.Materials and methods: The PubMed/MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov databases were searched with the term 'anakinra.' Results were manually screened to identify published data on off-label uses of anakinra in dermatologic conditions and systemic conditions with prominent dermatologic manifestations.Results: Anakinra appears to show efficacy for numerous dermatologic conditions, with the strongest evidence for hidradenitis suppurativa, Bechet's disease, Muckle-Wells syndrome, and SAPHO syndrome. Case reports and case series data are available for numerous other dermatologic conditions.Conclusion: Anakinra is a potential option for patients with certain difficult-to-treat dermatologic diseases, given its relatively benign adverse effect profile and its effectiveness in a wide array of conditions. Overall, anakinra appears to be a promising option in the treatment of numerous dermatologic inflammatory conditions refractory to first line therapies, but further and higher-quality data is needed to clarify its therapeutic role.
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Affiliation(s)
- Kyle Tegtmeyer
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Giancarlo Atassi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey Zhao
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nolan J Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter A Lio
- Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Medical Dermatology Associates of Chicago, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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