Abatacept for severe anti–tumor necrosis factor α refractory juvenile idiopathic arthritis–related uveitis

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Abstract
Objective: To evaluate the safety and efficacy of abatacept in patients with severe juvenile idiopathic arthritis (JIA)–related uveitis refractory or intolerant to immunosuppressive and anti–tumor necrosis factor α (anti‐TNFα) agents.Methods: Patients with JIA‐related uveitis refractory to immunosuppressive and anti‐TNFα agents were treated with intravenous abatacept (10 mg/kg monthly). Side effects, frequency of uveitis flares, and ocular complications before and after treatment were reported.Results: Seven patients (6 females and 1 male) with a mean uveitis duration of 11.6 years entered the study. All patients had failed previous immunosuppressive therapy and ≥2 anti‐TNFα treatments. All patients responded to abatacept and 6 maintained a clinical remission after a mean of 9.2 months of treatment. One patient withdrew from the study with oral mycosis and arthritis flare; no other patients had side effects. The mean frequency of uveitis flares during the 6 months before and after treatment decreased from 3.7 to 0.7 episodes. No new ocular complications or worsening of preexisting ones were reported.Conclusion: Abatacept treatment led to sustained improvement in severe anti‐TNFα–resistant JIA‐related uveitis and was well tolerated in all but 1 patient. These results provide new insights into a possible indication of abatacept for the treatment of uveitis.

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