Abstract
Purpose: :
To evaluate the clinical outcome and safety of treatment with Adalimumab in patients with refractory uveitis.
Methods: :
This is a retrospective case series study. Clinical records of patients who were treated in a compassionate basis with Adalimumab from April 2006 to April 2011 at University of Buenos Aires, due to refractory uveitis to conventional immunosuppressive therapy (IMT) were included. Clinical records with a follow up of less than 6 months were excluded. Adults were treated with a dose of Adalimumab 40 mg every other week (q.o.w.). Children were treated with a dose of Adalimumab 20 mg q.o.w.Collected data from patients included age, gender, time of follow up, duration of treatment, diagnosis, visual acuity, anterior inflammation, posterior inflammation, initial dose of corticosteroids (CS), dose of CS at 6 months, dose of CS at 12 months, reduction of IMT at 6 months, reduction of IMT at 12 months, and adverse events.
Results: :
Clinical records of 20 patients were included (14 female), with a mean age of 20.9 years (range= 4 - 51 ys), a mean follow-up of 45.2 months (range= 8 -132 m), and a mean duration of treatment of 14.85 months (range= 8 - 45 m).Diagnosis included Juvenile Idiopathic Arthritis (JIA) in 5 patients, Vogt Koyanagi Harada Syndrome (VKH) in 11 patients, Behcet Disease (BD) in 2 patients, Chronic Idiopathic Anterior Uveitis (CIAU) in 1 patient, and Birdshot Choroidopathy in 1 patient.Before initiation of treatment with adalimumab, all patients with diagnosis of VKH were treated with IMT. At the last visit of follow up during adalimumab treatment only 4 patients continued to receive IMT. Before initiation of treatment with adalimumab, 8 of 11 patients with VKH received CS. After 6 months of follow up during treatment with adalimumab, 5 patients were treated with more than 8 mg of CS, while 12 months after initiation of treatment only one patient received 8 mg per day. Anterior inflammation was reduced dramatically in patients with VKH after 6 months of treatment with adalimumab.After 6 months of treatment none of patients with chronic anterior uveitis (CAU) were treated with topical CS. Anterior inflammation was not observed in 8 of 12 eyes with CAU.Flare-up during tapering off medication was found in 5 patients (3 patients with VKH, 1 patient with JIA, 1 patient with BD).Adverse events occurred in 1 patient with BD who developed optic neuropathy.
Conclusions: :
In this series adalimumab has been used successfully in refractory cases of intraocular inflammation, including childhood uveitis. Adalimumab is a promising drug for the therapy of uveitis, while there are still some concerns regarding how and when to taper and stop this treatment. Further studies are needed to clarify these findings.
Keywords: autoimmune disease • uveitis-clinical/animal model • immunomodulation/immunoregulation