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Claudia Castiblanco, C. Stephen Foster; Treatment of Pediatric Uveitis with Adalimumab: The MERSI Experience. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2540.
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To evaluate adalimumab therapy in the pediatric population.
Retrospective case series. The electronic health records of pediatric patients diagnosed with uveitis and being treated with adalimumab therapy were reviewed. Demographic information, site and degree of intraocular inflammation, visual acuity, underlying systemic disorders, duration of therapy, side effects, and ability to obtain steroid-free remission were recorded.
Seventeen patients were included. Nine males and 8 females (mean age, 12 years). Sixteen patients had anterior uveitis and 1 patient had panuveitis with 14 patients having bilateral disease. Juvenile idiopathic arthritis had been diagnosed in 14 patients, sarcoidosis in 1 patient, and idiopathic etiology in 2 patients. Thirteen patients (76.5%) were able to achieve steroid-free remission while 4 patients (23.5%) did not achieve remission. Six patients flared after discontinuation of adalimumab with evidence of inflammation being noted 3 to 7 months later. Duration of adalimumab therapy ranged from 12 to 64 months with a mean of 36 months. Initial dosing ranged from 20 mg SC (47%) to 40 mg SC (53%) with initial intervals of every week (17.6%) to every 2 weeks (82.3%). 16 patients had used and/or failed other immunomodulatory agents prior to starting adalimumab. At the time of initiation, 14 patients used other agents in conjunction to adalimumab, 3 patients were on monotherapy, 13 patients had active inflammation, and the mean visual acuity was 20/30 OD and 20/40 OS. At 1 year follow up, 12 patients were using combination therapy, 3 patients were on monotherapy, 11 patients had no evidence of inflammation and the mean visual acuity was 20/25 OD and 20/32 OS. The most common additional agents used were Methotrexate and Mycophenolate mofetil. Skin infections were the most common infection noted in 4 patients. Side effects included pain at site of injection in 3 patients, anemia in 1 patient , and depression in 1 patient.
In our pediatric population, adalimumab was effective in inducing steroid-free remission. It was well tolerated and used in combination therapy with other immunomodulatory agents safely. The dosing and the interval can be adjusted to further improve inflammation control.
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