Adalimumab therapy in patients with vision threatening uveitis

Abstract

Purpose : The aim of this multicentre retrospective study was to review the outcomes of a large group of patients treated with systemic biologic therapy.

Methods : Retrospective chart review of patients with refractory non-infectious active uveitis treated with adalimumab was conducted. The main outcome measures were ability to reduce prednisolone dose, ability to taper immunosuppressives, final visual acuity and time to treatment failure or relapse.

Results : Forty-Six (46) uveitis patients on adalimumab were included in the study. There were 26 (56.5%) male patients and 20 (43.5%) female patients with 43 (93.5%) patients having bilateral active uveitis. The most common anatomical uveitis phenotype was panuveitis (n=17, 37.0%), followed by anterior uveitis (n=12, 26.1%), posterior uveitis (n=10, 21.7%) and intermediate uveitis (n=7, 15.3%). The most common diagnosis of patients on adalimumab was idiopathic uveitis (undifferentiated) (n=19, 41.3%). During follow-up, 35 (76.1%) patients were able to taper and discontinue corticosteroids, while 10 (21.7%) patients were able to taper corticosteroids <7.5mg per day. One (2.2%) patient required a prednisolone dose of 10 mg and one (2.2%) is on a weaning dose of steroids expected to be below 7.5mg/day. The mean visual acuity at the latest follow-up of the worse eye was logMAR 0.42 (SD 0.72), while the mean visual acuity of the better eye was logMAR 0.19 (SD 0.34). Of the 89 eyes, 21 (23.6%) eyes improved by at least 2 lines, 5 eyes (5.6%) deteriorated by 2 or more lines while vision was unchanged in the remaining 6 (70.8%) eyes. The person-years to recurrence was 1 in 12.47 person-years for adalimumab, with a 17.4% (8 patient) relapse rate. In this study, the length of time between diagnosis and commencement of adalimumab was shorter if diagnosed n 2016 or later, compared to diagnosis prior to 2016 (p<0.001). There were no serious adverse events.

Conclusions : This study highlights the importance of commencing adalimumab early in patients with sight threatening or poorly controlled uveitis to maximise visual outcomes, decrease ocular complications, and to reduce prednisolone dosage.

This is a 2021 ARVO Annual Meeting abstract.