To switch or to swap? Evidence from a meta-analysis for the best treatment approach in childhood chronic uveitis resistant to the I anti-TNF.

Autor:	Maccora I; Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy.; NeuroFARBA Department, University of Florence, Florence, Italy., Soldovieri S; Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy., Oliverio T; Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy., de Masi S; Clinical Trial Center, Careggi University Hospital, Florence, Italy., Marrani E; Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy., Pagnini I; Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy., Mastrolia MV; Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy.; NeuroFARBA Department, University of Florence, Florence, Italy., Simonini G; Rheumatology Unit, ERN ReCONNET Centre, Meyer Children's Hospital IRCCS, Florence, Italy.; NeuroFARBA Department, University of Florence, Florence, Italy.
Jazyk:	angličtina
Zdroj:	Journal of translational autoimmunity [J Transl Autoimmun] 2024 Jun 22; Vol. 9, pp. 100247. Date of Electronic Publication: 2024 Jun 22 (Print Publication: 2024).
DOI:	10.1016/j.jtauto.2024.100247
Abstrakt:	Objective: Since adalimumab approval in childhood chronic non-infectious uveitis (cNIU), the prognosis has been dramatically changed, but the 25 % failed to achieve inactivity. There is not accordance if it is better to switch to another anti-TNF or to swap to another category of biologic. Thus, we aim to summarize evidence regarding the best treatment of cNIU refractory to the first anti-TNF. Methods: A systematic literature review and meta-analysis, according to PRISMA Guidelines, was performed(Jan2000-Aug2023). Studies investigating the efficacy of treatment in cNIU refractory to the first anti-TNF were considered for inclusion. The primary outcome was the improvement of intraocular inflammation according to SUN. A combined estimation of the proportion of children responding to switch or swap and for each drug was performed. Results: 23 articles were eligible, reporting 150 children of whom 109 switched anti-TNF (45 adalimumab, 49 infliximab, 9 golimumab) and 41 swapped to another biologics (31 abatacept, 8 tocilizumab and 1 rituximab). The proportion of responding children was 46 %(95 % CI 23-70) for switch and 38 %(95 % CI 8-73) for swap (χ 2 0.02, p = 0.86). Instead analysing for each drug, the proportion of responding children was the 24 %(95 % CI 2-55) for adalimumab, 43 %(95 % CI 2-80) for abatacept, 79 %(95 % CI 61-93) for infliximab, 56 %(95 % CI 14-95) for golimumab and 96 %(95 % CI 58-100) for tocilizumab. We evaluated a superiority of tocilizumab and infliximab compared to the other drugs(χ 2 27.5 p < 0.0001). Conclusion: Although non-conclusive, this meta-analysis suggests that, after the first anti-TNF failure, tocilizumab and infliximab are the best available treatment for the management of cNIU. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2024 The Authors. Published by Elsevier B.V.)
Databáze:	MEDLINE
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