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The effectiveness of long-term infliximab [IFX] in refractory non-infectious childhood uveitis and the impact of treatment adherence on disease control were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective, single-center study between December 2002 and April 2016 of 27 children with refractory non-infectious uveitis [17 with juvenile idiopathic arthritis, JIA] treated with long-term IFX [9+ months]. Disease activity was assessed prior to and while on IFX using the Standardization of Uveitis Nomenclature [SUN]. Number of visits per year with active uveitis was analyzed by repeated measures logistic regression analysis from 2\u2009years prior to IFX initiation or from onset of uveitis until most recent visit on IFX. Incomplete treatment adherence was assessed for each visit and defined as any deviance in corticosteroid use, prescribed infusion frequency, and\/or follow-up examination frequency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Primary outcomes were sustained uveitic and systemic disease control prior to and during IFX treatment and the impact of incomplete adherence on uveitic disease control while on IFX. Secondary outcomes included corticosteroid and glaucoma medication requirement, ocular complications and need for surgical intervention. Mean age at IFX initiation was 10.4\u2009\u00b1\u20094.5\u2009years; initial mean dose was 6.6\u2009\u00b1\u20092.2\u2009mg\/kg [and given at weeks 0, 2, 4 and q4 weeks thereafter for 93%]. Median duration on IFX was 35 [range 9\u2013128] months. Prior to IFX, 14\/27 patients had failed adalimumab \u00b1 methotrexate [MTX]; 21\/27 failed MTX. IFX led to uveitis control in 89% and arthritis control in 76% (13\/17). The odds ratio of having controlled disease after IFX was 4.1 (2.6, 6.4) compared to pre-treatment visits. Topical corticosteroids and glaucoma medications were statistically decreased (<jats:italic>p<\/jats:italic>\u2009=\u20090.007 right eye [OD], 0.003 left eye [OS] and<jats:italic>p<\/jats:italic>\u2009=\u20090.001 OD,<jats:italic>p<\/jats:italic>\u2009=\u20090.028 OS respectively). Incomplete adherence to treatment showed 10.3 times greater odds (7.1, 15.0) of having disease activity than full adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study adds significantly to the IFX literature by documenting outstanding uveitis control with long-term IFX treatment in non-infectious pediatric uveitis patients. Higher dosage and shorter interval were utilized without adverse effects. Importantly, this is the first study, to our knowledge, to document the significant impact of treatment adherence on uveitis control.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12969-019-0383-9","type":"journal-article","created":{"date-parts":[[2019,11,29]],"date-time":"2019-11-29T15:03:04Z","timestamp":1575039784000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9671-3483","authenticated-orcid":false,"given":"Virginia","family":"Miraldi Utz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Bulas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Lopper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Fenchel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Sa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitul","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Lovell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam H.","family":"Kaufman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,29]]},"reference":[{"issue":"11","key":"383_CR1","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1001\/jamaophthalmol.2016.3229","volume":"134","author":"JE Thorne","year":"2016","unstructured":"Thorne JE, Suhler E, Skup M, et al. 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This study is retrospective without use of any individual\u2019s protected health information in this published work. Gaining consent would be unduly burdensome given the time period of the study and inability to contact patients who have left the practice.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Authors do not have conflict of interest or relationships relevant to this research. Individual disclosures include: <i>S. Bulas, S. Lopper, D. Ash, T. Sa- No financial interests or relationships to disclose; A. Kaufman [Alcon, 1800 Contacts]; V. Miraldi Utz [Spark Therapeutics \u2013Advisor, Springer-Textbook Royalties, Retrophin \u2013 Research]<\/i> M. Mehta [Carl Zeiss Meditech, jCyte \u2013 Research, Alimera, Allergan, Clearside, DORC \u2013 Consultant, Eyedaptic \u2013 Equity], <i>D. Lovell [Cincinnati Children\u2019s Hospital Medical Center receives payment for the work of Dr. Daniel Lovell from Astra-Zeneca, Centocor, Amgen, Bristol Meyers Squibb, AbbVie, Pfizer, Roche, Novartis, UBC, Ablynx, Boehringer-Ingelheim, Janssen, Lilly, Medimmune; Dr. Lovell is a member of DSMBs for Forest Research Institute and NIH-NIAMS and speaker\u2019s bureaus for Genentech and Bristol Meyers Squibb].<\/i>","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"79"}}