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The Safety and Efficacy of a Tumor Necrosis Factor Receptor Fusion Protein on Uveitis Associated With Juvenile Rheumatoid Arthritis

Phase 2
Not Enrolling
Juvenile Rheumatoid Arthritis, Uveitis

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Trial Information

The Safety and Efficacy of a Tumor Necrosis Factor Receptor Fusion Protein on Uveitis Associated With Juvenile Rheumatoid Arthritis

Current treatment modalities for uveitis associated with Juvenile Rheumatoid Arthritis (JRA)
including corticosteroids and other immunosuppressive agents are associated with significant
side effects. These treatments are not effective for all children. A soluble tumor
necrosis factor receptor (TNFR:Fc) named Etanercept, may inhibit the inflammatory response
of uveitis. This randomized double-masked phase I/II clinical trial will provide limited
safety and efficacy information regarding the use of Etanercept for the treatment of uveitis
associated with JRA. Fifteen patients will be randomized with a 2 to 1 randomization plan
(10 to receive Etanercept, 5 to receive placebo) and followed for 6 months. After the 6
month visit, all patients will receive open label Etanercept for an additional 6 months.
Patients will be switched to open label Etanercept, or withdrawn from study therapy prior to
6 months, if they a) experience a greater than 10 letter or greater drop in visual acuity
due to inflammation, for patients using the ETDRS chart (a 2 line drop due to inflammation,
for patients using the B-VAT method) or b) develop a sight-threatening inflammatory
ophthalmic or joint lesion requiring immediate increase in systemic anti-inflammatory
therapy or a periocular injection of corticosteriods or c) at 4 months, have greater than 1
plus anterior chamber cell grade in either eye and are receiving topical corticosteroids on
a schedule of TID or more frequently. Investigators will remain masked to original
treatment assignment unless warranted by clinical care considerations. Primary safety
outcomes include the occurrence of any severe adverse event at least possibly related to
study therapy, including a two step increase in anterior chamber cells, or the occurrence of
serious infection or sepsis. Primary ophthalmic outcomes include measures of anterior
chamber cells and a change in topical or systemic anti-inflammatory medications used to
treat uveitis. Primary ophthalmic and JRA outcome analysis will be performed at 6 months,
and again at 12 months. Patients unmasked or switched to open label Etanercept prior to
month 6 or withdrawing from the study drug prior to month 12 will be considered failures.

Inclusion Criteria


Meet American College of Rheumatology Criteria for JRA.

Have active anterior uveitis defined as the presence of inflammatory cells (Grade 1+ or
higher) in the anterior chamber of at least one eye or the current use of topical
corticosteroids to control exacerbation of disease at a frequency of TID or higher.

Be between 2 and 18 years, inclusive.

Be able to undergo slit lamp biomicroscopy for assessment of anterior chamber cells.

Be able to comply with study requirements.

Be up to date on all recommended childhood immunizations.

Have been using current arthritis regimen for at least 8 weeks prior to enrollment.


Have a media opacity that precludes assessment of anterior chamber inflammation.

Have a periocular injection of corticosteroids within 2 months of baseline, or used a
systemic experimental therapy within one month of baseline evaluation.

Be currently receiving disease modifying antirheumatic therapy (DMARD), with the exception
of prednisone at a dose no greater than 1.0 mg/kg/day, or methotrexate at a dose no
greater than 15 mg/m(2)/week.

Have active eye or joint inflammation requiring immediate addition or increase in systemic
anti-inflammatory medications.

Be a Female who is pregnant or lactating .

Refuse to use contraception during the study and 6 months after termination of active
study therapy, if child-bearing or fathering potential exists.

Have used Latanoprost within two weeks prior to enrollment, or have a current or likely
need for Latanoprost during the course of the study.

Have hypersensitivity to fluorescein dye.

Have active serious infections or history of recurring serious infections.

Evidence of spondyloarthropathy or entheseopathy.

Type of Study:


Study Design:

Endpoint Classification: Safety/Efficacy Study, Primary Purpose: Treatment


United States: Federal Government

Study ID:




Start Date:

February 1999

Completion Date:

March 2003

Related Keywords:

  • Juvenile Rheumatoid Arthritis
  • Uveitis
  • Ocular Inflammation
  • Children
  • Immunotherapy
  • Cytokine
  • Clinical Trial
  • Uveitis
  • Immunosuppression
  • Joint
  • Inflammation
  • Arthritis
  • Arthritis, Rheumatoid
  • Inflammation
  • Uveitis
  • Chorioretinitis
  • Arthritis, Juvenile Rheumatoid



National Eye Institute (NEI) Bethesda, Maryland  20892