Abstract
Purpose :
Adalimumab is approved for the treatment of non-infectious uveitis (NIU) patients. There is limited data on the efficacy of adalimumab in specific disease subtypes. We sought to assess the need for rescue in sarcoid associated uveitis (SAU) and retinal vasculitis (RV) patients on adalimumab utilizing clinical exam findings and fluorescein angiography imaging characteristics.
Methods :
In this IRB approved retrospective case series, 40 adult NIU patients (n=80 eyes) (17 males; 23 females) (26 White; 11 Black; 1 Asian; 2 Other) on adalimumab with a baseline visit and at least one month of follow-up visits were identified. 21 of 40 patients (6M; 15F) were diagnosed with RV; 19 of 40 (11M; 8F) were diagnosed with SAU. Follow-up visits for each group were compared for worsening inflammatory changes and rescue treatments involving additional immunosuppression at 3, 6, and 12 months.
Results :
Consecutive rescues at 3, 6, and 12 months revealed lower rates among sarcoid patients (13%, 29%, 34%) versus those with retinal vasculitis (20%, 40%, 50%). Seven patients (3 SAU; 4 RV) required increased adalimumab at weekly dosage. 30 of 80 eyes (16 of 40 patients) required rescue within one year (38%/40%). 13 of 78 eyes (7 of 39 patients) required rescue at three months (17%/18%). 17 of 80 eyes (9 of 40 patients) required rescue at six months (21%/23%). 18 of 80 eyes (10 of 40 patients) required rescue at 12-months (23%/25%). 17 eyes (9 patients) required at least two rescues (21%/23%). Rescues per patient per year were 0.175 events. Seven patients (5 SAU; 2RV) (6%; 3%) were rescued with topical immunosuppressive drops; nine patients (3 SAU; 6RV) (4%; 8%) with intraocular steroid injections/implants; eight patients (3 SAU; 5 RV) (8%; 13%) with oral steroids. Three patients discontinued adalimumab: one SAU patient at 12 months; two RV patients at 6 months. Three patients switched to another immunomodulatory agent: one SAU patient to secukinumab at 12 months; two RV patients to infliximab at 12 months.
Conclusions :
In our patient series, adalimumab was associated with lower rates of treatment failure in patients with sarcoidosis in comparison to those with retinal vasculitis. About 40% of NIU patients on adalimumab required rescue treatment within one year. 37 of 40 patients in our year-long series continued treatment on adalimumab.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.