Earlier therapy reduces need for surgery in JIA-related uveitis

NASHVILLE, Tenn. — The sooner a patient with juvenile idiopathic arthritis-related and idiopathic uveitis receives both methotrexate and a second immunomodulatory therapy agent, the sooner the patient will experience better control over the uveitis, according to a study.

“Earlier initiation of both methotrexate and a second IMT [immunomodulatory] agent, if required, is associated with a reduced likelihood of needing any ophthalmic surgeries at 3 years. [Patients] are less likely to need more than three times a day of topical prednisolone, and [there is] overall improved uveitis control,” Crystal S. Cheung, MD, said at the American Association for Pediatric Ophthalmology and Strabismus meeting.

Crystal S. Cheung

The retrospective chart review, from January 1998 to December 2016, included 49 patients with juvenile idiopathic arthritis (JIA)-related and idiopathic uveitis treated at a single center with methotrexate alone or with methotrexate plus a second IMT agent and followed up for at least 2 years. Patients were divided to take into consideration those diagnosed before or after the FDA approval of adalimumab for the treatment of JIA in February 2008, with 23 patients diagnosed before December 31, 2008, and 26 diagnosed after. The researchers studied whether the increased availability of adalimumab as an off-label use for JIA-related uveitis influenced outcomes.

There was a statistically significant difference (P = .0005) in the time interval between uveitis onset and IMT initiation in the group diagnosed after 2008, with those patients having a reduced need for any ophthalmic surgery at 3 years (P = .005), suggesting earlier initiation of immunosuppressant is associated with a reduced need for ophthalmic surgery, Cheung said.

Patients diagnosed with uveitis after 2008 who received methotrexate and a second IMT had less need for topical prednisolone and less active uveitis, Cheung said. – by Robert Linnehan

Reference:

Cheung CS, et al. Is the use of systemic immunosuppression in juvenile idiopathic arthritis (JIA)-related and idiopathic uveitis associated with fewer ophthalmic surgeries? Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; April 2-6, 2017; Nashville, Tenn.

Disclosure: Cheung reports no relevant financial disclosures.