Non-infectious Chronic Uveitis in Childhood: Assessment and Treatment in the Biological Era

Purpose of reviewReport of currently available treatment strategies for childhood chronic uveitis in the biologic era.Recent findingsThe management of non-infectious chronic uveitis in children is based on immunomodulatory treatment. In case of failure to conventional disease-modifying anti-rheumatic drugs (cDMARDs) and/or frequent flares, tumor necrosis factor alfa (TNF-alpha) blocking agents represent the first biologic choice. Adalimumab is the TNF-alpha inhibitor more frequently adopted. Two multicenter, double-blind, randomized, placebo-controlled trials stated its efficacy and safety in this clinical setting.For refractory diseases, not responsive to TNF-alpha inhibitors, emerging biologic therapies have been reported. Most of the current literature refers to expert opinion and remains non-standardized. However, retrospective studies and short-case series report tocilizumab, abatacept, and rituximab as promising biologic alternatives in patients with refractory, sight-threatening uveitis even in children. A window of opportunity is currently emerging for JAK inhibitors.SummaryThe role of anti-TNF-alpha inhibitor in chronic uveitis therapy met unanimous level of agreement. Rescue therapy approach still remains controversial. Randomized controlled trials and large series with long-term follow-up are mandatory to assess efficacy, safety, and cost-effectiveness in this challenging disease.