Email: rb. Received Dec 10; Accepted Sep 4. Abstract Background Psoriasis is immune-mediated chronic inflammatory disease with preference for skin and joints. The skin involvement occurs by hyperproliferation and abnormal differentiation of keratinocytes. It is associated with comorbidities, mainly related to the clinical manifestations of the metabolic syndrome.
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Abstract Background Refractory non-infectious uveitis is a serious condition that leads to ocular complications and vision loss and requires effective systemic treatment to control disease. The effectiveness of long-term infliximab [IFX] in refractory non-infectious childhood uveitis and the impact of treatment adherence on disease control were evaluated.
Number of visits per year with active uveitis was analyzed by repeated measures logistic regression analysis from 2 years prior to IFX initiation or from onset of uveitis until most recent visit on IFX. Results Primary outcomes were sustained uveitic and systemic disease control prior to and during IFX treatment and the impact of incomplete adherence on uveitic disease control while on IFX. Secondary outcomes included corticosteroid and glaucoma medication requirement, ocular complications and need for surgical intervention.
Mean age at IFX initiation was Median duration on IFX was 35 [range 9—] months. The odds ratio of having controlled disease after IFX was 4.
Incomplete adherence to treatment showed Conclusions This study adds significantly to the IFX literature by documenting outstanding uveitis control with long-term IFX treatment in non-infectious pediatric uveitis patients. Higher dosage and shorter interval were utilized without adverse effects. Importantly, this is the first study, to our knowledge, to document the significant impact of treatment adherence on uveitis control.
Ocular inflammation can be associated with systemic disease, most commonly Juvenile Idiopathic Arthritis [JIA] [ 1 ] or may be idiopathic. Therefore, timely diagnosis and initiation of an effective management protocol are strongly indicated. While local and systemic therapy with corticosteroids may be utilized as initial treatment, ocular [ 7 , 8 ] and systemic [ 9 ] side effects of long-term administration warrant early implementation of corticosteroid-sparing therapy to improve visual outcomes [ 8 , 10 ].
To successfully manage and to treat uveitis, frequent appointments and complicated medication regimens are often needed. Adherence to both treatment and follow-up evaluations are paramount to treatment success of uveitis [ 27 , 28 ]. Children represent a vulnerable population, and treatment success may largely depend on the partnership between the caregivers and the clinicians to promote adherence. Uveitis with or without JIA has the potential to leave residual and permanent disability, which has life-long consequences for these children.
One of the benefits of IFX is that the clinician can track infusion administration. Therefore, understanding the impact of adherence on treatment efficacy and disease control is an important endeavor. In this study, we evaluate the long-term use of IFX to sustain control of inflammation and impact of treatment adherence in a single center study of children with recalcitrant NIU.
The number of patients in this study is larger than relevant publications in the literature. Methods Institutional review board approval was obtained, and the study adhered to the Declaration of Helsinki. Complete ophthalmology records included all visit notes and examination findings and were collected systematically via an IRB-approved data collection sheet for each patient. Data included demographic information, ophthalmologic and rheumatologic examinations, results of laboratory testing, systemic diagnoses, all prior and current systemic treatments, IFX dosage and frequency, treatment adherence, ocular medications [dose and route of administration] prior to and during treatment with IFX Additional file 1 : Table S1.
The anatomic location and grading of intraocular inflammation were in accordance with the Standardization of Uveitis Nomenclature [SUN] Classification Scale [ 30 ]. Non-adherence to infusion was determined reviewing the dates of each infusion procedure within the electronic medical record. The use of systemic medications such as methotrexate and topical corticosteroids was self-reported.
Outcome measures The clinical examination prior to starting IFX was compared to the most recent visit while on IFX and included best-corrected visual acuity [BCVA], intraocular pressure [IOP], ocular inflammation [ 30 ], and presence or absence of active arthritis when applicable. Ocular complications and surgical interventions prior to and while on IFX were assessed.
Complications included band keratopathy [BK], ocular hypertension [OHT], glaucoma, anterior and posterior synechiae, hypotony, and cystoid macular edema [CME].
Complications were as defined by Woreta et al. IFX-related adverse events were evaluated. Adherence was evaluated for each visit while on IFX. Active anterior segment inflammation corresponded to cell grade 0. Visits with active disease per year before and during IFX treatment were compared via a repeated measures logistic regression analysis.
The effect of adherence on disease control for each clinical visit while on IFX was calculated by a repeated measures logistic regression analysis.
Baseline and at most recent visit weekly topical corticosteroid burden before and while on IFX were compared using a paired t-test. We assessed topical glaucoma medication use via Wilcoxon signed-rank analysis at baseline, defined as before or within six months of IFX initiation, and during IFX use starting six months into treatment.
The six-month timeframe was selected to allow adequate time for full effectiveness of IFX in combination with being able to slowly taper topical steroids and subsequently taper glaucoma medications accordingly. SAS 9.
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