March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Adalimumab (Humira™) For The Treatment Of Refractory Uveitis And Scleritis
Author Affiliations & Notes
  • Neal V. Palejwala
    Ophthalmology, Emory University, Atlanta, Georgia
  • Jonathan Waltuck
    Ophthalmology, Emory University, Atlanta, Georgia
  • Farzin Forooghian
    Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada
  • Steven Yeh
    Ophthalmology, Emory University, Atlanta, Georgia
  • Footnotes
    Commercial Relationships  Neal V. Palejwala, None; Jonathan Waltuck, None; Farzin Forooghian, None; Steven Yeh, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 5493. doi:
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      Neal V. Palejwala, Jonathan Waltuck, Farzin Forooghian, Steven Yeh; Adalimumab (Humira™) For The Treatment Of Refractory Uveitis And Scleritis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5493.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose:
 

Adalimumab is a recombinant human IgG1 monoclonal antibody targeting TNF-α. Recent studies have shown its success in treating autoimmune disease including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We reviewed our experience with adalimumab for the treatment of noninfectious uveitis.

 
Methods:
 

Retrospective interventional case series of patients with uveitis treated with adalimumab from the Emory Eye Center and the University of British Columbia. Demographic information, anatomic and etiologic diagnoses, oral and topical corticosteroid use, concomitant immunosuppression, visual acuity and ocular inflammation scores were reviewed.

 
Results:
 

Thirteen eyes of 10 patients were reviewed. All patients received adalimumab 40mg subcutaneously every 2 weeks except for 1 patient with bilateral panuveitis secondary to Behcet’s disease who received 40mg subcutaneously every 1 week. All patients were female with a mean age of 30.6 yrs (Range 8-65). Anatomic diagnoses included anterior (2), anterior/intermediate (1), and panuveitis (7). 3 patients with panuveitis had concomitant scleritis. Disease etiologies/associations included rheumatoid arthritis, Behcet’s, sarcoidosis (2), sympathetic ophthalmia, HLA-B27-associated arthritis (3).The mean best corrected visual acuity at adalimumab initiation and at end of follow-up or time of discontinuation (in logMAR units) was 0.8 ± 0.8 and 0.7 ± 0.8 respectively (p=0.29). The level of anterior chamber inflammation at the same time points was 0.6 ± 0.7 and 0.2 ± 0.3 respectively (p=0.05).In patients who were able to continue adalimumab, the systemic corticosteroid requirement was reduced from a mean of 22.5 mg/day (Range 5-80) to 5.5 mg/day (Range 0-20, p=0.08) while the average dosage of topical corticosteroid requirements decreased from 3.1±2.3 to 1.8±2.1 respectively (p=0.06).Mean follow up was 8.3±9.9 months. 3 patients discontinued the drug during follow-up (i.e. 2 for lack of efficacy and 1 for undesirable weight gain). No severe adverse events were observed.

 
Conclusions:
 

In this small, retrospective series, adalimumab was moderately effective and safe as a corticosteroid-sparing medication, allowing the tapering of corticosteroid in 70% of patients. Further study is needed regarding the precise treatment indications and role of adalimumab for uveitis and scleritis.

 
Keywords: inflammation • immunomodulation/immunoregulation • uveitis-clinical/animal model 
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