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M. Zierhut, H. Michels, R. Haefner, J. Kuemmerle–Deschner, D. Doycheva, C.M. E. Deuter; Adalimumab in the Treatment of Chronic Anterior Uveitis in Children . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1526.
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Chronic anterior uveitis in children often takes a serious course. Despite various immunosuppressive drugs some children do not sufficiently respond with high risk of becoming seriously disabled. Anti–TNF alpha therapy has been shown to be mostly ineffective (Etanercept) or partly effective (Infliximab) with the risk of anaphylactic reactions. Here we report on 14 young patients treated with Adalimumab (Humira®), a complete humanized anti–TNF alpha antibody.
In a retrospective study 14 patients were treated with Adalimumab (20–40 mg every 2 weeks, when ineffective every week); 10 had juvenile idiopathic arthritis, 2 had HLA–B27 + arthritis, 2 were without detectable disease. The age varied from 7–23 (mean age 15.8 years). Patients were included when the previous anti–inflammatory therapy had been ineffective. This consisted of systemic steroids (n=14), Cyclosporin A (n=14), Methotrexate (n=14), Azathioprine (n=9), Mycophenolate mofetil (n=4), Cyclophosphamide (n=2), Etanercept (n=7) and Infliximab (Remicade®) (n=2). The grading for uveitis was: effective: no relapse or more than 2 relapses less than before treatment, mild: one relapse less than before treatment, no response: no change in relapse rate, worsening: more relapses under treatment than before. The grading for arthritis (depending on the clinical findings) was: effective, mild, no response, worsening.
For arthritis (n=12) the response to Adalimumab was effective in 7 of 11 patients, mild in 2 patients, 3 did not show response. For uveitis (n=14) the response was effective in 12, and 2 patients did not show an effect. After good response at the beginning in 2 children a shorter application time had to be used to continue the good anti–inflammatory effect. Additional immunosuppressive treatment was used in 6 of the effectively treated children. Due to elevation of liver enzymes in 1 patient, who also had MTX, Adalimumab had been stopped. No child reported about anaphylactic reactions or more infections since begin of Adalimumab treatment.
In our young patients Adalimumab was effective or mild effective against the arthritis in 82%, but also in uveitis in 86%. While these results regarding arthritis are comparable with other TNF–alpha blocking drugs (Etanercept), Adalimumab seems to be much more effective against the uveitis than Etanercept. Anaphylactic reactions, known from Infliximab, are not seen with Adalimumab.
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