Adalimumab in the Treatment of Non-infectious Uveitis: A Study from the United Kingdom: Part 1 Effectiveness

Abstract

Purpose : Adalimumab, an anti-tumour necrosis factor-alpha inhibitor, is an effective treatment for uveitis. In the United Kingdom (UK), adalimumab is licensed for the treatment of non-infectious uveitis affecting the posterior segment and unresponsive to conventional
disease-modifying anti-rheumatic drugs (cDMARDs) or immunosuppressants. There is significant value in reporting real world outcomes for the use of this agent since the uses and outcomes may differ from those seen during pivotal trials.

Methods : Retrospective cohort study including 202 adult patients with non-infectious uveitis initiated on adalimumab between September 2013 and May 2021 at our tertiary centre. Those established on adalimumab for at least 12 months were analysed. Data included patients’ characteristics at the time of adalimumab initiation, and follow-up visits at 6, 12 and 24 months (±3 months in view of variable follow-up times). Aim was to determine the glucocorticoid-sparing effect of adalimumab, choice of cDMARD and adalimumab biosimilars used.

Results : 125 (61.9%) female and 77 (39.1%) male patients with an average age of 47±15 met criteria for analysis. Most patients identified as Caucasian (n=107(53%)). Birdshot retinochoroiditis was the most frequent aetiology (54 (26.7%)) with idiopathic uveitis the next most common (n=50 (24.8%)). Bilateral non-infectious uveitis was present in the majority of patients (n=179 (88.6%)). Mean duration in months of adalimumab therapy was 46 ±18.4. Most patients were initiated on Hyrimoz® (n=111 (55.0%)) with the remainder commenced on Humira® (n=90 (44.6%) or Amgevita®(n=2 (1%)). Prior to adalimumab commencement, 195 (92.9%) patients were on cDMARDs compared to 139 (66.2%) patients at 12 months. On initiation of adalimumab, 134 (66.3%) patients were on ≤10mg per day of oral Prednisolone, 86 (43%) of which were on ≤5mg a day. At 12 months, 167(66.3%) patients were on ≤10mg per day of prednisolone with 126 (62.3%) on ≤5mg a day. The steroid sparing effect of adalimumab as determined by event rate per patient years of ≤10mg and ≤5mg prednisolone per day was 0.87 and 0.66 respectively. Adverse events reported by 24 months include bacterial infection (n=38 (18.8%)), COVID-19 infection (n=19 (9.4%)) and neoplasia (n=7 (3.5%)).

Conclusions : Adalimumab is an effective treatment for uveitis. At 12 months our study concluded that our adalimumab patients required less oral Prednisolone.

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