5 April 2011
Doctors at Bristol Royal Hospital for Children are planning a
major UK-wide clinical trial which they hope will prevent blindness
in children with arthritis.
Up to 25 children with arthritis will be recruited onto the
trial at Bristol Royal Hospital for Children from the summer.
With funding of £1.5m from Arthritis Research UK and the
National Institute for Health Research Health Technology Assessment
(NIHR HTA) programme, the trial aims to recruit more than 150
children with juvenile idiopathic arthritis (JIA) nationwide, who
are at risk of uveitis, a serious inflammatory eye condition which
in severe cases can lead to blindness.
The study will be run by chief investigators Dr Athimalaipet
Ramanan, lead consultant in paediatric rheumatology at Bristol
Royal Hospital for Children, and Dr Michael Beresford, senior
lecturer in paediatric medicine and honorary consultant paediatric
rheumatologist, at Alder Hey Childrens NHS Foundation Trust in
Liverpool.
The trial will test the effectiveness of a powerful biologic
drug called adalimumab, which is currently licensed to treat adults
with rheumatoid arthritis, and teenagers between the ages of 13 and
16 with JIA.
However, doctors hope that if they can show the drug to be both
safe and effective in reducing uveitis, it could also be approved
for use in children with arthritis of all ages, in a range of
doses.
JIA is a form of inflammatory joint disease that affects around
15,000 children and teenagers between the ages of six months and 17
years.
Fourteen paediatric rheumatology centres in the UK will start
recruiting youngsters later this year. Participants will stay on
the treatment for at least a year.
Up to 30 per cent of children with JIA are at risk of uveitis,
and in one third of these children, the disease is of sufficient
severity to cause visual loss, cataracts, increased pressure in the
eye and blindness, explained Dr Ramanan. If this trial shows that
adalimumb is effective, it would be great news for children with
JIA whose eyes are affected.
Current treatments are steroid eye drops, and for those with
severe disease, a drug called methotrexate, which is a standard
treatment for inflammatory forms of arthritis. Neither is a cure,
but both relieve symptoms to some extent.
The trial will test the effectiveness of giving adalimumab,
given per injection every two weeks, with methotrexate - which is
known to be effective in treating the symptoms of inflammatory
arthritis - compared to methotrexate on its own. Earlier, small
studies have shown that children taking adalimumab have shown
significant improvement in their uveitis.
Funding for the Arthritis Research UK part of the trial has been
provided by a private donor.
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