Adalimumab in the treatment of refractory non-infectious scleritis: 6-month outcomes

Abstract

Purpose : Use of adalimumab in the treatment of refractory scleritis remains limited due to a lack of evidence in the literature that would justify its high cost. Since scleritis is rare, there are no large-scale randomised controlled trials evaluating treatment efficacy. We conducted this retrospective case series with an aim to report 6-month outcomes of non-infectious, refractory scleritics treated with adalimumab at our tertiary centre.

Methods : Retrospective analysis included 15 adult scleritics with refractory non-infectious disease initiated on adalimumab between Sept 2014 and Oct 2021 at our tertiary centre. Data was collected from clinic letters accessed from electronic records. Patients’ baseline characteristics and 6-month outcomes were analysed to determine the steroid-sparing effect, impact on visual acuity and the time to first scleritis flare-up since commencement of adalimumab. Aim was to establish whether adalimumab is effective after 6 months of treatment in the subset of scleritics not responding to conventional treatment with oral corticosteroids and/or corticosteroid-sparing agents.

Results : Before commencement of adalimumab, 46.7% of patients were taking ≤10mg of oral prednisolone, and 26.7% were on ≤5mg. Fraction of patients on ≤10mg and ≤5mg of daily prednisolone increased after 6 months of adalimumab therapy to 93.3% and 60%. Rate of sclertic reactivation on adalimumab was 0.62 flare-ups/patient-year, with 4 patients developing flare-ups in the initial 6-month period. None of the patients experienced worsening of their vision, with 27% achieving better vision. Four patients experienced side events (ie. oral & genital thrush, adalimumab injection pain, headaches, nausea & 1 episode of bleeding gums).

Conclusions : This case series demonstrates that adalimumab is effective after 6 months treatment in the majority of non-infectious scleritis patients who were previously refractory to conventional therapy. We hope that our findings can support consideration of adalimumab therapy in patients with refractory scleritis.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Characteristics of 15 patients with scleritis treated with adalimumab.
Abbreviations: Rheumatoid arthritis (RA), Human leukocyte antigen (HLA), anti-neutrophil cytoplasmic antibody (ANCA)

 

Flare-ups on adalimumab during the first 6 months of treatment. Flare-ups defined as active disease on symptoms or examination & needing increased immunosuppression.