Juvenile idiopathic arthritis (JIA)-associated uveitis is the most common cause of paediatric uveitis and is associated with significant visual morbidity.1 Despite considerable improvements in the treatment of JIA, most trials of biological agents in JIA excluded children with uveitis for methodological reasons. This has meant a limited evidence base and availability of biological therapies for paediatric uveitis. The ADJUVITE study2 published in this journal and the recently published SYCAMORE study3 both provide much needed evidence for use of biologics in children with uveitis. The ADJUVITE study2 randomised 32 patients with childhood onset anterior uveitis and an inadequate response to topical steroid and methotrexate (MTX), based on a laser flare photometry (LFP) reading of ≥30 photon units/ms, to fortnightly adalimumab or placebo. The primary outcome was response to treatment at the end of month 2, defined as a reduction of at least 30% of ocular inflammation on LFP with no worsening of anterior chamber cells or flare according to Standardised Uveitis Nomenclature (SUN) criteria.4 In the adalimumab group, 9/16 patients had a 30% reduction in flare on LFP compared with 3/15 in the placebo group, which was statistically significant, but as the authors acknowledge should be interpreted with some caution as the CI included 1. There was no significant reduction in anterior chamber cell scores. This small study, following on from the SYCAMORE trial,3 which was stopped early due to evidence of efficacy of adalimumab for JIA-associated uveitis, provides further support for the use of adalimumab in childhood uveitis. However, there are striking differences between the ADJUVITE …

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阿达木单抗治疗儿童葡萄膜炎

幼年特发性关节炎 (JIA) 相关性葡萄膜炎是小儿葡萄膜炎的最常见原因，并且与显着的视力发病率有关。1 尽管 JIA 的治疗有了相当大的改进，但由于方法学原因，JIA 中的大多数生物制剂试验都排除了儿童葡萄膜炎。这意味着小儿葡萄膜炎的生物疗法的证据基础和可用性有限。发表在本杂志上的 ADJUVITE 研究 2 和最近发表的 SYCAMORE 研究 3 都为在患有葡萄膜炎的儿童中使用生物制剂提供了急需的证据。ADJUVITE 研究 2 根据激光耀斑光度 (LFP) 读数≥30 光子单位/毫秒，将 32 名儿童期发病的前葡萄膜炎和对局部类固醇和甲氨蝶呤 (MTX) 反应不足的患者随机分配至每两周一次的阿达木单抗或安慰剂。主要结果是在第 2 个月结束时对治疗的反应，定义为根据标准化葡萄膜炎命名法 (SUN) 标准，LFP 眼部炎症减少至少 30%，且前房细胞没有恶化或耀斑。4在阿达木单抗组中，与安慰剂组中的 3/15 相比，9/16 患者的 LFP 发作减少了 30%，这具有统计学意义，但正如作者承认的那样，应谨慎解释，因为 CI 包括 1。有前房细胞评分没有显着降低。这项小型研究是继 SYCAMORE 试验 3 之后，由于阿达木单抗对 JIA 相关葡萄膜炎有效的证据而提前停止的研究，为阿达木单抗在儿童葡萄膜炎中的使用提供了进一步的支持。但是，ADJUVITE 之间存在显着差异……