Biological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review

Luiz Fernando Norcia,1 Olívia Pereira Kiappe,2 Eliane Chaves Jorge2 1Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; 2Department of Surgical Specialties and Anesthesiology (Ophthalmology Division), Botucatu Medical School, São Paulo State University (UNESP),...

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Autores principales:	Norcia LF, Kiappe OP, Jorge EC
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	uveitis children biological therapy systematic review. Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/e1091a047662408f9fffa5b2e60c231f
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spelling	oai:doaj.org-article:e1091a047662408f9fffa5b2e60c231f2021-12-02T19:12:05ZBiological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review1177-5483https://doaj.org/article/e1091a047662408f9fffa5b2e60c231f2021-09-01T00:00:00Zhttps://www.dovepress.com/biological-therapy-in-noninfectious-pediatric-uveitis-a-systematic-rev-peer-reviewed-fulltext-article-OPTHhttps://doaj.org/toc/1177-5483Luiz Fernando Norcia,1 Olívia Pereira Kiappe,2 Eliane Chaves Jorge2 1Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; 2Department of Surgical Specialties and Anesthesiology (Ophthalmology Division), Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, BrazilCorrespondence: Eliane Chaves JorgeDepartment of Surgical Specialties and Anesthesiology, São Paulo State University (UNESP), Medical School, Ave. Professor Mário Rubens Guimarães Montenegro s/n, Botucatu, 18618-687, São Paulo, BrazilEmail eliane.jorge@unesp.brPurpose: Noninfectious pediatric uveitis is a potentially blinding disease often associated with systemic conditions. In cases of chronic anterior uveitis without adequate response to steroids and immunosuppressants, biological response modifiers would be viable therapeutic options. Still, evidence is lacking on the safety of the long-term use of these drugs in children. Therefore, this study aimed to evaluate the efficacy and safety of biological therapy to treat noninfectious pediatric uveitis.Methods: A systematic review was performed to identify original studies involving biological therapy for children diagnosed with noninfectious uveitis. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) classification system.Results: Nine studies involving 526 children were eligible. Adalimumab was superior to placebo in reducing inflammatory activity (risk ratio (RR) 3.21 [95% confidence interval (CI) 1.65– 6.27]; P = 0.0006; I2 = 0%) and steroid use (RR 2.27 [95% CI 1.03– 4.99]; P = 0.04; I2 = 0%, low-certainty evidence). There was no difference between adalimumab and placebo in the occurrence of systemic adverse events (RR 2.51 [95% CI 0.74– 8.54]; P = 0.14; I2 = 48%) and local events (RR 1.15 [95% CI 0.46– 2.88]; P= 0.76; I2 = 1%). There was no difference between adalimumab and infliximab in response to treatment (RR 1.18 [95% CI 0.69– 2.03]; P= 0.55; I2 = 91%, very low-certainty evidence) and in the occurrence of adverse effects (RR 0.84 [95% CI 0.41– 1.73]; P= 0.64; I2 = 18%, low-certainty evidence).Conclusion: There is low to very-low evidence that biological therapy is effective and safe in managing noninfectious pediatric uveitis. Future large randomized trials may provide more substantial evidence to confirm these results.Keywords: uveitis, children, biological therapy, systematic reviewNorcia LFKiappe OPJorge ECDove Medical Pressarticleuveitischildrenbiological therapysystematic review.OphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 3765-3776 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	uveitis children biological therapy systematic review. Ophthalmology RE1-994
spellingShingle	uveitis children biological therapy systematic review. Ophthalmology RE1-994 Norcia LF Kiappe OP Jorge EC Biological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review
description	Luiz Fernando Norcia,1 Olívia Pereira Kiappe,2 Eliane Chaves Jorge2 1Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; 2Department of Surgical Specialties and Anesthesiology (Ophthalmology Division), Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, BrazilCorrespondence: Eliane Chaves JorgeDepartment of Surgical Specialties and Anesthesiology, São Paulo State University (UNESP), Medical School, Ave. Professor Mário Rubens Guimarães Montenegro s/n, Botucatu, 18618-687, São Paulo, BrazilEmail eliane.jorge@unesp.brPurpose: Noninfectious pediatric uveitis is a potentially blinding disease often associated with systemic conditions. In cases of chronic anterior uveitis without adequate response to steroids and immunosuppressants, biological response modifiers would be viable therapeutic options. Still, evidence is lacking on the safety of the long-term use of these drugs in children. Therefore, this study aimed to evaluate the efficacy and safety of biological therapy to treat noninfectious pediatric uveitis.Methods: A systematic review was performed to identify original studies involving biological therapy for children diagnosed with noninfectious uveitis. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) classification system.Results: Nine studies involving 526 children were eligible. Adalimumab was superior to placebo in reducing inflammatory activity (risk ratio (RR) 3.21 [95% confidence interval (CI) 1.65– 6.27]; P = 0.0006; I2 = 0%) and steroid use (RR 2.27 [95% CI 1.03– 4.99]; P = 0.04; I2 = 0%, low-certainty evidence). There was no difference between adalimumab and placebo in the occurrence of systemic adverse events (RR 2.51 [95% CI 0.74– 8.54]; P = 0.14; I2 = 48%) and local events (RR 1.15 [95% CI 0.46– 2.88]; P= 0.76; I2 = 1%). There was no difference between adalimumab and infliximab in response to treatment (RR 1.18 [95% CI 0.69– 2.03]; P= 0.55; I2 = 91%, very low-certainty evidence) and in the occurrence of adverse effects (RR 0.84 [95% CI 0.41– 1.73]; P= 0.64; I2 = 18%, low-certainty evidence).Conclusion: There is low to very-low evidence that biological therapy is effective and safe in managing noninfectious pediatric uveitis. Future large randomized trials may provide more substantial evidence to confirm these results.Keywords: uveitis, children, biological therapy, systematic review
format	article
author	Norcia LF Kiappe OP Jorge EC
author_facet	Norcia LF Kiappe OP Jorge EC
author_sort	Norcia LF
title	Biological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review
title_short	Biological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review
title_full	Biological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review
title_fullStr	Biological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review
title_full_unstemmed	Biological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review
title_sort	biological therapy in noninfectious pediatric uveitis: a systematic review
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/e1091a047662408f9fffa5b2e60c231f
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Biological Therapy in Noninfectious Pediatric Uveitis: A Systematic Review

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