Temporal trends in systemic therapies in childhood non- infectious uveitis
This retrospective study of the CORPUS cohort reveals a significant temporal shift in the management of childhood non-infectious uveitis from 2016 to 2025, characterized by a progressive move toward biologic therapies—particularly adalimumab—while methotrexate monotherapy use declined.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the delicate landscape of a child's eye, inflammation can be a silent thief, stealing sight long before a parent notices a change. When this inflammation, known as uveitis, occurs without an infection, it is often a stubborn, chronic condition that requires powerful medicines to calm the immune system. For decades, doctors have relied on a class of drugs called disease-modifying antirheumatic drugs, or DMARDs, to stop the body from attacking itself. Among these, methotrexate has long been a standard first choice, acting as a broad suppressant of the immune response. However, as medical science has advanced, a newer generation of medicines called biologics has emerged. These are highly targeted agents, often designed to block specific proteins that drive inflammation, offering a more precise way to control the disease while trying to avoid the side effects of older, broader treatments. The question facing specialists today is not just whether these new tools work, but how they are actually being used in the daily care of children, and whether the medical community is shifting its habits to embrace them over the older standards.
A team of researchers at the University Hospital of Marseille in France set out to map this shift in real-world practice. They looked back at the medical records of 140 children who had been treated for chronic non-infectious uveitis between January 2016 and November 2025. This was not a controlled experiment where doctors followed a strict script; instead, it was an observation of how treatment evolved naturally in a busy, expert clinic. The researchers tracked every systemic medication prescribed to these children, noting which drugs were used, when they were started, and how often they were combined. Their goal was to see if the patterns of care changed over the years, moving away from older therapies toward newer, more targeted options.
The data revealed a clear and steady transformation in how these children were treated. Over the decade of the study, the use of adalimumab, a biologic drug that targets a specific inflammatory protein, grew consistently. It became the most frequently prescribed biologic agent, used either on its own or alongside other medicines. The researchers found that the likelihood of a child receiving this treatment increased slightly but significantly with each passing year. In contrast, the use of methotrexate as the sole treatment for a child's condition dropped sharply. By the end of the study period, methotrexate monotherapy accounted for only a small fraction of prescriptions, down from being a dominant strategy in earlier years. This suggests that doctors are increasingly moving away from relying on a single, older drug to manage the condition, preferring instead to use more targeted biologics or combinations of therapies.
The study also highlighted the arrival of other newer treatments. The use of golimumab, another biologic agent, was non-existent before 2020 but began to appear in prescriptions shortly after, rising to a small but noticeable level by 2025. Meanwhile, the use of tocilizumab remained steady, used in a small number of cases where other treatments might not have been sufficient. Throughout this entire period, the use of prednisone, a common steroid used to quickly reduce swelling, remained low and stable, hovering between roughly 3 percent and 13 percent of treated patients. This indicates that the shift toward biologics is helping doctors keep children off high doses of steroids, which can have serious long-term side effects for growing bodies.
The researchers concluded that the management of childhood uveitis is undergoing a quiet but profound evolution. The landscape is no longer dominated by a single, older drug but is becoming more diverse, with biologics taking a central role. This change reflects a growing confidence in these newer agents and a desire to tailor treatment more carefully to each child's needs. While the study was limited to a single hospital and involved a relatively small number of patients, the trends observed are strong and consistent. They show that in the real world, outside of clinical trials, doctors are actively adopting these advanced therapies to better protect the vision of children with this challenging condition. The future of care appears to be moving toward a more personalized approach, where the right biologic is chosen to control inflammation with greater precision and fewer side effects.
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