Purpose

Registry-based observational prospective study aimed at describing the use of biologic disease modifying anti-rheumatic drugs (bDMARDs) in pediatric-onset scleritis

Methods

55 patients diagnosed with non-infectious scleritis were enrolled from November 2020 in the AIDA International Registry for patients with non-infectious Scleritis. Among these patients, those whose age at disease onset was ≥18 years or never treated with any bDMARDs were excluded from the study. The efficacy of bDMARDs on pediatric-onset scleritis was evaluated in terms of control of scleral inflammation, number of ocular relapses, steroid-sparing effect, and visual acuity. Data were collected at baseline, at 3-, 6-, 12-month follow-up and at last assessment.

Results

Five patients (9 eyes) treated with adalimumab, infliximab, abatacept and secukinumab for pediatric-onset non-infectious scleritis were included. Mean age at the time of enrollment in the registry was 16.6±5.2 years. Mean age at scleritis onset and diagnosis were 10.3±2.9 and 11.7±4.5 years respectively. Scleritis was bilateral in 4 cases, unilateral in 1. Four patients (7 eyes) manifested diffuse posterior scleritis;1 patient had bilateral nodular posterior with nodular anterior scleritis in 1 eye. Median bDMARDs treatment duration was 28 months. At 6-months, scleritis resolved in all eyes. At 12-months, complete disease control was observed in 7/9 eyes (77.8%). The number of relapses 12-months before and after treatment initiation was 17 and 2, respectively. Mean BCVA was 0.83 (range 0.3-1.0) at baseline and 1.0 for all eyes after 12 months. Steroids had been withdrawn in 4/5 patients.

Conclusions

Biological agents proved to be effective in pediatric-onset scleritis, allowing a noticeable steroid-sparing effect and preserving visual function and bulbar integrity.