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Background/Purpose: There is no clear standard of care for the treatment of juvenile uveitis when initial steroid therapy is insufficient. We sought to assess current prescribing practices in the treatment of this condition with steroid-sparing medications. For this study, we focused on children with idiopathic, non-infectious uveitis. Methods: This is a cross-sectional cohort study of idiopathic uveitis patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) data registry. Clinical characteristics, including demographic information, presenting features, disease complications, and medications were collected. Descriptive statistics were used to characterize the cohort. Chi-square and Fisher's exact t-test analyses were used to assess for associations between medications and clinical characteristics. Results: There were 92 children with idiopathic uveitis identified, of which 41 (45%) were male. The majority (62%) had anterior uveitis, followed by panuveitis (21%), intermediate (13%), and posterior (4%) uveitis. Average age of onset was 8.4 years. Caucasians represented 77% of the cohort; 13% were Hispanic. Among the 76 patients (83%) who had been treated with a non-biologic DMARD, 70 had received methotrexate (MTX). The initial form of administration (oral versus subcutaneous) was inferred based on categorization of medication use as “current,” “past,” or “never.” Of the 67 patients for whom timing of administration could be determined, 36 received subcutaneous MTX as initial therapy, while 31 initially received oral MTX. Caucasian patients were more likely to receive oral MTX first (p = 0.046) as compared to non-Caucasians, and there was a trend towards subcutaneous administration in younger patients (mean 7.4 versus 9.1 years, p = 0.06). In addition, 49 patients (53%) had received a biologic agent, all TNF inhibitors: infliximab (n = 36), adalimumab (n = 18), or golimumab (n = 1). Of these, all but 2 had also received MTX. Use of a biologic agent was positively associated with cataract development (p = 0.003), although rates of vision loss and overall complications were not higher in patients treated with biologics. Patients who had received a biologic agent were more likely to have a positive ANA, although this association was not statistically significant (p = 0.07). Age, race, and sex were not associated with the use of biologics. Conclusion: Most children with idiopathic uveitis enrolled in the CARRA registry were treated with methotrexate, ith the form of administration divided equally between oral and subcutaneous dosing. Factors associated with initial use of oral versus subcutaneous MTX include race and possibly age. Patients who received a biologic agent were more likely to have cataracts, suggesting that biologics might be used more often in patients with more severe disease or those requiring chronic corticosteroids. However, the overall uveitis complication rate was not higher in patients treated with biologics. Many variables likely contribute to the selection of medications used to treat juvenile uveitis; further elucidation of these factors will be necessary for the development of consensus treatment plans. |
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