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Jonathan Tak Loong Lee, William Yates, Sophie Rogers, Denis Wakefield, Peter J McCluskey, Lyndell L Lim; Efficacy of adalimumab for refractory noninfectious uveitis in Australia. Invest. Ophthalmol. Vis. Sci. 2018;59(9):404.
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Adalimumab has recently been approved by the U.S. Food and Drug Administration for the treatment of adults with noninfectious intermediate, posterior and panuveitis following two large randomized controlled trials1-2. The aim of this study was to compare the efficacy of adalimumab in patients with refractory active and inactive noninfectious uveitis in a real-world setting.1N Engl J Med. 2016;375(10):932-432Lancet. 2016;388(10050):1183-92
Retrospective chart review of all patients with noninfectious uveitis treated with adalimumab at the Royal Victorian Eye and Ear Hospital, St Vincent’s Hospital Sydney and Sydney Eye Hospital from November 2010 through to October 2016. Demographics, type of uveitis, systemic treatments, ocular examination findings, and side effects were recorded. Main outcomes included corticosteroid-sparing effect, ability to taper immunomodulators, and a composite endpoint of treatment failure encompassing active inflammatory chorioretinal or retinal vascular lesions, degree of anterior and posterior chamber inflammation, and visual acuity.
Twenty-two patients (37 eyes) were identified. Mean follow-up was 19.7 months. Twelve patients (55%) had posterior or panuveitis and 10 patients (45%) had isolated anterior uveitis. Mean duration of uveitis at baseline was 83.2 months. The most common diagnoses were Behçet's disease (N=8, 36%), undifferentiated inflammation (N=5, 23%), ankylosing spondylitis (N=4, 18%) and juvenile idiopathic arthritis (N=3, 14%). The majority of patients (N=15, 68%) had been previously treated with ≥2 immunomodulators in addition to prednisolone.Oral prednisolone was reduced to ≤10mg/day in 75% of patients (N=9) by 6 weeks. At 6 months of therapy, 90% of the active eyes (N=9) achieved a 2-step improvement in anterior chamber inflammation, with 60% (N=6) demonstrating a similar improvement in vitreous haze grade. Almost all (N=17, 94%) of the initially inactive eyes remained clinically quiescent at this time point. The incidence of treatment failure during follow-up was 88 per 100 eye-years for the active eyes, and 26 per 100 eye-years for the inactive eyes. No serious adverse effects were recorded.
Adalimumab was effective in reducing the corticosteroid burden in patients with refractory noninfectious uveitis. Eyes that had active inflammation at the time of adalimumab commencement were more likely to fail therapy than eyes that were inactive.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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