Efficacy of Adalimumab in Adult and Pediatric Refractory Uveitis: A Multicenter Study

Abstract

Purpose: : The aim of this study was to assess the efficacy and safety of adalimumab in treating refractory autoimmune uveitis.

Methods: : : This work was a retrospective, noncomparative, nonrandomized, international, multicenter study. Seventy-two patients with refractory uveitis of different etiologies (Juvenile Idiopathic Arthritis, Pars Planitis, Behçet Disease, Vogt Koyanagy Harada syndrome, Ankilosing Spondilitis, Inflammatory Bowel Disease, Sarcoidosis, Lupus, Rheumatoid Arthritis, Birdshot Coriorretinopathy, Sympathetic Ophthalmia, and uveitis of Idiopathic origin) meeting eligibility criteria received a 40-mg subcutaneous (s.c.) injection of adalimumab every other week during 6 months.

Results: : All patients underwent an outcome assessment at month 6. All patients had an active intraocular inflammation at baseline, and 51 patients (70%) achieved control of their inflammation with adalimumab at the end of follow-up. After optic coherence tomography, 20 patients (28%) had cystoid macular edema (CME) at baseline, and at the end of follow-up there was a complete resolution of CME in 14 of these 20 eyes. All patients were able to reduce at least 50% of the dose of the concomitant immunosuppressive drugs at the end of follow-up. Adalimumab was well tolerated in all patients, and only local minor side effects at the s.c. injection site were observed. Nevertheless, 9 patients (12%) had moderate to severe relapses during the follow-up period, and 17 patients (23.6%) had minor relapses during the follow-up that were controlled with 1 periocular steroid injection.

Conclusions: : Adalimumab seems to be an effective, safe therapy for the management of refractory uveitis and may provide the possibility to reduce the concomitant immunosuppressive drugs in these patients. Further long-term studies are warranted to determine the safety and efficacy of adalimumab in treating intraocular inflammation.

Keywords: inflammation • uveitis-clinical/animal model • uvea