Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Use of Abatacept for Childhood Refractory Vision-Threatening Uveitis.
Simonini2, Gabriele, De Cinzia1, Libero, Caputo1, Roberto, Giani2, Teresa, Pascoli2, Laura, Pagnini2, Ilaria, Cimaz2, Rolando
Improvement of refractory JIA-related uveitis has been reported with Abatacept.
Aim of our study was to evaluate the efficacy and safety of Abatacept in an open-label prospective, monocenter, study of childhood non-infectious chronic uveitis.
Four patients with refractory, vision-threatening non-infectious uveitis were enrolled to receive Abatacept 10 mg/kg at weeks 0, 2, 4, and thereafter monthly, for at least 6 months. Absence/recurrence rate of uveitis throughout the study period, according to the SUN Working Group criteria, visual acuity pre- and post-Abatacept treatment, and tapering of steroid medication were recorded. Improved visual acuity was defined as a doubling of the visual angle (converted in a LogMAR format) in at least one eye. All children had active uveitis: 6 out of 8 eyes were involved, despite treatment with methotrexate (MTX) (15 mg/m2/weekly) in association with Infliximab (6 mg/kg every 68 weeks) followed by Adalimumab (24 mg/m2, every other week), then by mycophenolate mofetil in 3 cases; and by Adalimumab in 1 case. Due to active uveitis, along with topical steroids, all children were also receiving oral prednisone (12 mg/kg/day), at stable doses for at least 6 weeks (range 4555 days).
Demographics, clinical characteristics and outcomes on treatment are reported in the Table.
Median time of abatacept treatment was 10 months (range 614). During treatment, all children achieved a complete remission over a median period of 12 weeks (range 814). Steroid administration was discontinued during the first 6 months (range 46) in 3/4 children. The patient with Blau syndrome was able to taper the dose down to 0.3 mg/kg/day. In all children, no relapse of uveitis occurred during treatment, whilst during the 6 month-period before starting Abatacept, the median number of relapses was 4 (range 36). At 6 months of treatment, all patients, (5/8 eyes), met the criteria for improved visual acuity. Two children reached a completely normal visual acuity, while the other two improved, eventhough the pre-existing complications, due to chronic uveitis, affected a complete recovery. No major side effects, infusion reactions and/or drug-related adverse events were recorded during the treatment period.
Even if limited to a small group, our results suggest that Abatacept may be effective and safe in chronic refractory childhood uveitis, both in JIA-uveitis and in not JIA-uveitis.
To cite this abstract, please use the following information:
Simonini, Gabriele, De Cinzia, Libero, Caputo, Roberto, Giani, Teresa, Pascoli, Laura, Pagnini, Ilaria, et al; Use of Abatacept for Childhood Refractory Vision-Threatening Uveitis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :240