TNF-α blockers and demyelinating lesions in pediatric non-infectious uveitis: Insights from a real world cohort.
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PURPOSE: To characterize childhood non-infectious uveitis (NIU) patients who developed demyelinating lesions during TNF-α blocker therapy and to investigate potential risk factors associated with this pathology. METHODS: This retrospective single-center cohort study included pediatric NIU patients treated with TNF-α blockers who had undergone brain magnetic resonance imaging (MRI) at any time during the course of the disease. Demographic and clinical characteristics, the ocular complication score (OCS), and imaging data were reviewed. RESULTS: The study cohort included 45 patients with a mean age of 13.8±4.46 (5-22) years. The mean duration of TNF-α blocker treatment within the study period was 44±27.9 months. The OCS did not significantly change from baseline to final visit (P=0.10). Brain MRI was performed before initiation of TNF-α blocker therapy in 21 (46.6%) patients and during treatment in 24 (53.4%). All demyelinating lesions were detected on MRIs obtained after TNF-α blocker initiation (median: 52 months; range 18-84). Central nervous system (CNS) demyelinating lesions were identified in 4 (8.8%) patients; two were diagnosed with multiple sclerosis, and two with radiologically isolated syndrome. CONCLUSION: CNS demyelination was uncommon but clinically relevant in pediatric NIU patients receiving TNF-α blockers. Demyelinating lesions may be associated with pars planitis, neurologic symptoms, and/or a family history of demyelinating disease. During treatment, CNS MRI may be considered when new neurologic symptoms accompany an uncontrolled uveitis flare, particularly in the presence of newly developed ocular inflammatory findings.