Early Initiation of TNF Inhibitors for Tubulointerstitial Nephritis and Uveitis (TINU).
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PURPOSE: Tubulointerstitial nephritis and uveitis (TINU) syndrome is traditionally treated with corticosteroids followed by antimetabolites. The efficacy of early tumor necrosis factor-α (TNF) inhibitor therapy in TINU has not been sufficiently assessed. This case series describes the ocular and renal outcomes of treating TINU with TNF inhibitors (TNFi) and antimetabolites. METHODS: Retrospective data was collected on medication use and outcomes in nine pediatric TINU patients. Patients were split based on corticosteroid-sparing therapy: Group A only used antimetabolites and Group B used TNFi. Groups were assessed for corticosteroid sparing efficacy, renal and ocular quiescence, and medication adverse effects. RESULTS: There were two Group A and seven Group B patients. Five Group B patients previously failed antimetabolite monotherapy. In Group A, median time from corticosteroid-sparing therapy initiation to prednisone cessation was 26.5 weeks, during which mean peak body mass index (BMI) increase was 1.65 kg/m2. In Group B, median corticosteroid sparing time was 28 weeks and mean BMI increase was 4.16 kg/m2. After removing time on antimetabolite monotherapy, median corticosteroid sparing time was 6 weeks and mean BMI increase was 2.03 kg/m2. Five patients taking antimetabolites and one taking TNFi had uveitis relapses. No renal relapses were reported. Only mycophenolate mofetil was associated with symptomatic adverse effects. CONCLUSIONS: TNFi controlled ocular and renal inflammation in TINU. Furthermore, some patients fail antimetabolite therapy and experience side effects of prolonged corticosteroid therapy. We recommend early and even first-line usage of TNFi as corticosteroid-sparing therapy with or without antimetabolites.