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Immunosuppressant drug shows promise in treating anterior uveitis from juvenile arthritis
Am J Ophthalmol. 2009;148(5):696-703.
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High doses of an immunosuppressant drug may reduce inflammation from anterior uveitis associated with juvenile idiopathic arthritis, according to a study.
The authors set out to gather preliminary data concerning the safety and efficacy of high-dose intravenous Zenapax (daclizumab, Roche) in treating the inflammatory condition.
The prospective, open-label, interventional phase 2 pilot study included six patients who received daclizumab doses of 8 mg/kg at baseline, 4 mg/kg at 2 weeks and 2 mg/kg every 4 weeks for 52 weeks total. The primary outcome measure was a two-step decrease in grade of inflammation identified at 12 weeks. The primary safety outcome was evaluated at 2 weeks and 4 weeks. Standardization of Uveitis Nomenclature criteria were used to assess ocular inflammation, the study authors said.
Four patients met the primary efficacy endpoint and had a two-step reduction in anterior chamber cells at 12 weeks. Mean visual acuity improved from 68 ETDRS letters in the worse eye to 79.6 letters, an increase equivalent to two Snellen lines.
Three patients were eliminated from the study before the 52-week endpoint because of a rash possibly caused by daclizumab, ocular treatment failure and uncontrolled systemic presentations of juvenile idiopathic arthritis, the authors said.
"Larger randomized trials are needed to better assess treatment effect and safety," they said.
This article provides information about a possible medication for the treatment of uveitis in patients with juvenile idiopathic arthritis (JIA). The number of patients reported in the paper is small and cannot allow for any determination as to how effective intravenous daclizumab is in the treatment of uveitis in these patients. Uveitis in patients with JIA can be a frustrating disorder to treat and many patients require corticosteroid sparing agents to prevent the possible side effects of their long-term use. Appropriately, this study does not attempt to discuss or advocate the use of intravenous daclizumab for these patients. It provides data to suggest that its use should be studied in a larger prospective trial.
– Scott E. Olitsky, MD
OSN
Pediatrics/Strabismus Board Member