Uveítis pediática no infecciosa, una experiencia de una cohorte colombiana


Autoria(s): Valdes Camacho, Juanita; Zuluaga Peña, Julio Ricardo; Bernal Macias, Santiago; de la Torre Cifuentes, Alejandra
Contribuinte(s)

Trillos Peña, Carlos Enrique

Hernandez Herrera, Gilma Norela

Espinosa-Aranzales, Angela-Fernanda

Torres de Galvis, Maria Yolanda

Data(s)

28/07/2015

Resumo

Resumen: •Antecedentes: La uveítis pediátrica no infecciosa tiene el potencial de desencadenar severas complicaciones visuales y su manejo farmacológico convencional está asociado a importantes efectos secundarios. 1 Infliximab (INF) y Adalimumab (ADA), son dos medicamentos biológicos disponibles para el manejo de la uveítis pediátrica refractaria. Se unen específicamente al TNFα y previenen la unión del mismo con los receptores celulares; interacción directamente implicada en el proceso inflamatorio y el subsecuente daño tisular. 2,3 •Métodos: Se realizó estudio de tipo cohorte retrospectiva mediante revisión de historias clínicas de 35 pacientes pediátricos diagnosticados con uveítis durante los años 2009-2015. Se comparó control de la inflamación ocular, tiempo de respuesta y eventos adversos en pacientes tratados con ADA o INF con dosis bajas de Metotrexate vs. Metotrexate (MTX) como única terapia. •Resultados: El 45.7% de la población estudiada correspondía al sexo femenino, cuya edad promedio de inicio de síntomas y de diagnósticos fue de 9 años. El 80% de los casos fueron uveítis idiopáticas, seguido por Vogt-Koyanagi-Harada (8,5%) y AIJ (5,7%). El 91,4% presentó compromiso ocular bilateral y se documentaron 2 casos de ambliopía. El 12,9% de los pacientes que recibieron MTX como tratamiento de primera línea requirieron escalonamiento terapéutico por presentar eventos adversos (Elevación de enzimas hepáticas e intolerancia gastrointestinal (GI)). El tiempo promedio para alcanzar control de la inflamación con MTX fue 9 semanas, y para Adalimumab fue de 8,75 semanas (P: 0,90). Se comparó la capacidad de controlar la inflamación del MTX vs Anti-TNF, y no se observaron diferencias significativas (P: 0.88).

Background: Non-infectious pediatric uveitis has the potential to produce severe visual complications and its traditional pharmacologic treatment is associated with severe adverse effects.1 Infliximab and Adalimumab are two Biologic Response Modifiers available for the treatment of refractory pediatric uveitis. They specifically attach to TNFα and prevent its interaction with its receptor, which is directly involved in the inflammation process and subsequent tissue damage. 2,3 •Methods: Retrospective cohort study was performed by means of a retrospective review of medical records of 35 patients diagnosed with uveitis during years 2009-2015. Comparisons between ocular inflammation control, time of response, and adverse effect in patients treated with IFN or ADA plus low doses of Methotrexate vs. Methotrexate (MTX) as unique therapy were performed. •Results: 45.7% of the population was female whose mean age for symptom onset and diagnosis was 9 years of age. 80% were idiopathic uveitis, followed by Vogt-Koyanagi-Harada (8,5%) y JIA (5,7%). 91,4% had bilateral ocular compromise and 2 cases of amblyopia were documented. 12,9% of the patients who received MTX as a first line treatment required step up treatment as a consequence of liver enzyme elevation and gastrointestinal discomfort. Mean time to achieve inflammation control with MTX was 9 weeks, and 8,75 weeks for Adalimumab, (P: 0,90). We compared MTX’s and Anti-TNF capacity to control ocular inflammation which showed no significant difference, (P: 0.88).

Formato

application/pdf

Identificador

http://repository.urosario.edu.co/handle/10336/11506

Idioma(s)

spa

Publicador

Facultad de medicina

Direitos

info:eu-repo/semantics/openAccess

Fonte

instname:Universidad del Rosario

reponame:Repositorio Institucional EdocUR

Lowder CY, Char DH. Uveitis—A Review. West J Med. 1984;140:421–432

Gallagher M, Quinones K, Cervantes-Castañeda RA, Yilmaz T, Foster CS. Biological response modifier therapy for refractory childhood uveitis. Br J Ophthalmol [Internet]. 2007 Oct [cited 2014 Sep 3]; 91(10):1341–1344.

Hood C, Lowder CY. Pediatric uveitis. Pediatr Retin. 2011;6(4):433–457

Smith J a., Mackensen F, Sen HN, Leigh JF, Watkins AS, Pyatetsky D, et al. Epidemiology and Course of Disease in Childhood Uveitis. Ophthalmology [Internet]. 2009 Aug [cited 2014 Sep 3]; 116(8):1544–51, 1551.e1

Santos Lacomba M, Marcos Martín C, Gallardo Galera JM, Gómez Vidal M a, Collantes Estévez E, Ramírez Chamond R, et al. Aqueous humor and serum tumor necrosis factor-alpha in clinical uveitis. Ophthalmic Res [Internet]. 2001; 33(5):251–5.

Vazquez-Cobian LB, Flynn T, Lehman TJ a. Adalimumab therapy for childhood uveitis. J Pediatr [Internet]. 2006 Oct; 149(4):572–5

Thadani SM, Foster CS. Treatment of ocular inflammation in children. Pediatr Drugs. 2004;6(5):289–301.

Nagpal A, Leigh JF, Acharya NR. Epidemiology of Uveitis in Children. 48(3):1–7.

Kump LI, Cervantes-Castañeda RA, Androudi SN, Foster CS. Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology. 2005 Jul;112(7):1287–92.

Besch D. Uveitis in Children Manfred Zierhut , MD Hartmut Michels , MD ¨ biger , MD Nicole Stu Christoph Deuter , MD Arnd Heiligenhaus , MD.

Holland GN, Stiehm ER. Special considerations in the evaluation and management of uveitis in children. Am J Ophthalmol [Internet]. 2003 Jun [cited 2014 Aug 25];135(6):867–878.

de-la-Torre A, López-Castillo CA, Rueda JC, Mantilla RD, Gómez-Marín JE, Anaya J-M. Clinical patterns of uveitis in two ophthalmology centres in Bogota, Colombia. Clin Experiment Ophthalmol. 2009 Jul;37(5):458–66

Workshop I. Standardization of Uveitis Nomenclature for Reporting Clinical Data. Results of the First International Workshop. Am J Ophthalmol. 2005 Sep;140(3):509–516

Delair E, Latkany P, Noble AG, Rabiah P, McLeod R, Brézin A. Clinical manifestations of ocular toxoplasmosis. Ocul Immunol Inflamm. 2011 Apr;19(2):91–102

de-la-Torre A, Stanford M, Curi A, Jaffe GJ, Gomez-Marin JE. Therapy for ocular toxoplasmosis. Ocul Immunol Inflamm. 2011 Oct;19(5):314–20.

Waller R, Wilkinson N. Eye disease in paediatric rheumatology. Paediatr Child Heal (United Kingdom) [Internet]. 2013 Feb [cited 2014 Sep 3]; 23(2):78–84.

Madigan WP, Raymond WR, Wroblewski KJ. Review Article A Review of Pediatric Uveitis : Part II . Autoimmune Diseases and Treatment Modalities. 2008;(1977).

Kalinina Ayuso V, Van De Winkel EL, Rothova A, De Boer JH. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis. Am J Ophthalmol [Internet]. 2011 Feb [cited 2014 Sep 3]; 151(2):217–222.

Rajaraman RT, Kimura Y, Li S, Haines K, Chu DS. Retrospective Case Review of Pediatric Patients with Uveitis Treated with Infliximab. 2006;:308–314.

Pato E, Muñoz-fernández S. Systematic Review on the Effectiveness of Immunosuppressants and Biological Therapies in the Treatment of Autoimmune Posterior Uveitis. YSARH [Internet]. 2011; 40(4):314–323

Neri P, Lettieri M, Fortuna C, Zucchi M, Manoni M, Celani S, et al. Review Article Adalimumab (Humira. 2010;17(4)

Knupp S, Oliveira F De, Almeida RG De, Fonseca AR, Cristine M, Rodrigues F, et al. Pacientes e métodos: 139–150.

Bravo-Ljubetic L, Peralta-Calvo J, Noval S, Pastora-Salvador N, Abelairas-Gómez J. Adalimumab therapy for refractory childhood uveitis. J AAPOS [Internet]. 2013 Oct [cited 2014 Sep 3]; 17(5):456–459.

Simonini G, Cantarini L, Bresci C, Lorusso M, Galeazzi M, Cimaz R. Current therapeutic approaches to autoimmune chronic uveitis in children. Autoimmun Rev [Internet]. 2010 Aug [cited 2014 Jul 28]; 9(10):674–683.

Simonini G, Taddio a, Cattalini M, Caputo R, DeLibero C, Pagnini I, et al. Superior efficacy of Adalimumab in treating childhood refractory chronic uveitis when used as first biologic. Pediatr Rheumatol. 2011;9(Suppl 1):P220.

Rosman Z, Shoenfeld Y, Zandman-goddard G. Biologic therapy for autoimmune diseases : an update. BMC Med [Internet]. 2013; 11(1):1.

Simonini G, Katie D, Cimaz R, Macfarlane GJ, Jones GT. Arthritis Care & Research This article has been accepted for publication and undergone full peer review but has not been through the copyediting , typesetting , pagination and proofreading process which may lead to differences between this version and the 2013

Knupp S, Oliveira F De, Almeida RG De, Fonseca AR, Cristine M, Rodrigues F, et al. Pacientes e métodos: 139–150.

Singh J. Practice refractory to methotrexate. CMAJ. 2013;185(9):793–795.

Wendling D, Paccou J, Berthelot JM, Flipo RM, Guillaume-Czitrom S, Prati C, et al. New onset of uveitis during anti-tumor necrosis factor treatment for rheumatic diseases. Semin Arthritis Rheum [Internet]. 2011 Dec [cited 2014 Aug 24]; 41(3):503–510

Rosman Z, Shoenfeld Y, Zandman-Goddard G. Biologic therapy for autoimmune diseases: an update. BMC Med [Internet]. 2013 Jan [cited 2014 Sep 3]; 11(1):88.

Tugal-Tutkun I. Pediatric uveítis. J Opthalmic Vis Res. 2011; 6 (4): 259-269

Lerman M.A, Lewen M.D, Kempen J.H, Mills M.D. Uveitis Reactivation in Children Treated with Tumor Necrosis Factor-α Inhibitors. Am J Ophthalmol. 2015 Apr 17

Shah SS, Lowder CY, Schmitt MA, et al. Low-dose methotrexate therapy for ocular inflammatory disease. Ophthalmology. 1992; 99:1419-1423.

Zierhut M, Michels H, Stübiger N, Besch D, Deuter C, Heiligenhaus A, Uveitis in children. International Ophthalmology Clinics: 2005; 2(45): 135-156.

TEME

Palavras-Chave #Epidemiología #617.71 #Uveítis #Enfermedades infecciosas #Oftalmología #Key words: Pediatric uveitis, Adalimumab, Infliximab, Methotrexate
Tipo

info:eu-repo/semantics/bachelorThesis

info:eu-repo/semantics/acceptedVersion