Adalimumab in the Treatment of Refractory Non-infectious Scleritis: 18-Month Outcomes

Abstract

Purpose : Adalimumab, a tumour necrosis alpha (TNF-alpha) inhibitor, has become a globally well-recognised treatment for refractory uveitis. Evidence generated from a recent case series provided an argument for expanding the use of adalimumab to patients with refractory non-infectious scleritis. Long-term outcomes are still underreported in this cohort of patients which makes conclusions on its overall efficacy challenging. Hence, we aim to report 18-month outcomes of patients with non-infectious, refractory scleritis treated with adalimumab at our tertiary referral centre.

Methods : We included 14 adult patients with refractory non-infectious scleritis initiated on adalimumab between September 2014 and October 2021 at our tertiary referral centre. One patient was excluded from the analysis due to non-compliance with adalimumab. Data was collected retrospectively from clinic letters accessed from the electronic patient record. Patients’ baseline parameters and 18-month outcomes were analysed to determine the glucocorticoid-sparing effect, rate of disease reactivation, reasons for stopping the treatment and presence of any significant adverse events.

Results : Out of 14 patients, 11 continued their adalimumab therapy for the duration of 18 months. Three patients stopped their treatment due to: ineffectiveness secondary to developing anti-adalimumab antibodies (n=2) and primary ineffectiveness, not associated with development of anti-adalimumab antibodies (n=1). On initiation of adalimumab, 28.6% of patients were on ≤5mg of daily prednisolone. This fraction has increased to 90.9% at 18 months (P < 0.004, Fisher exact test). The rate of disease reactivation was calculated as 1.01 flare-ups/patient-year. Four subjects did not experience any episodes of disease reactivation during the relevant follow-up period. Adverse events included pain on injecting adalimumab, a single episode of bleeding gums, headache and nausea, peripheral neuropathy and infection.

Conclusions : Our case series demonstrates a good response to adalimumab in the majority of patients after 18 months of treatment. Development of anti-adalimumab antibodies was an obstacle that stopped two patients (14%) from continuing long-term therapy. We hope this case series will contribute to further understanding of the role of adalimumab in the treatment of refractory scleritis.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Graph representing disease reactivation on adalimumab during 18 months of treatment.