Current evidence of methotrexate efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach
Evidence Based Medicine
Simonini G et al. – Although randomized controlled trials are needed, the available evidence supports the use of MTX in the treatment of childhood autoimmune chronic uveitis: approximately three–quarters of patients on MTX can expect improvement in intraocular inflammation.Methods
- A systematic search of articles between January 1990 and June 2011 was conducted using EMBASE, Ovid MEDLINE, Evidence-Based Medicine Reviews—ACP Journal Club, the Cochrane Library and EBM Reviews.
- Studies investigating the efficacy of MTX as a single immunosuppressant medication in the treatment of ACU refractory to therapy with topical treatment and/or systemic treatment in children (≤16 years) were eligible for inclusion.
- The primary outcome measure was the improvement of intraocular inflammation, expressed as Tyndall, as defined by the Standardization of Uveitis Nomenclature working group criteria.
- The effect measure for each study was the proportion of people classified as responders.
- The authors determined a combined estimate of the proportion of children in the eligible studies responding to MTX.
- The initial search identified 246 articles of which 52 were potentially eligible.
- Nine eligible articles, all retrospective chart reviews, remained in the analysis.
- The number of children in studies ranged from 3 to 25, and the dose of MTX varied from 7.5 to 30 mg/m2.
- Altogether, 95 of 135 children responded to MTX.
- The pooled analysis suggested that MTX has a favourable effect in the improvement of intraocular inflammation: the proportion of responding subjects was 0.73 (95% CI 0.66, 0.81).