Abstract
Purpose :
Adalimumab (an anti-tumour necrosis factor α, anti-TNF) is a treatment for ocular inflammation (eg. non-infectious uveitis). General ophthalmologists may be unfamiliar with screening patients for biological disease-modifying antirheumatic drugs (ie., bDMARD immunosuppressives). We describe our experience screening ophthalmic patients for adalimumab in the UK.
Methods :
Retrospective review of electronic patient records identified 515 patients (>16 years old) from Nov 2017 till Sept 2023 in our adalimumab screening clinic. Pharmacy dispensing data identified which patients never proceeded to adalimumab therapy. To rule out tuberculosis (TB), QuantiFERON TB Gold & chest x-rays are done; for intermediate uveitics & possible demyelination patients, MRI brain requested; for lupus, anti-nuclear antibodies & double stranded DNA (dsDNA) requested. Systemic examination & urine dipstick helps rule out neoplasia.
Results :
515 patients were seen, and 464 patients proceeded to adalimumab (90.1%). Of the 51 (9.9%) who did not continue to adalimumab, 15 (2.9%) were found to be medically contraindicated: 10 patients were contraindicated due to demyelination (i.e. radiologically isolated syndrome (RIS), n=7, 1.36%) or multiple sclerosis (MS, n=3, 0.6%). Other contraindications included cancer (n=2, 0.4%), systemic lupus erythematosus (SLE, n=1, 0.2%), latent TB awaiting treatment (n=1, 0.2%), or heart failure (n=1, 0.2%). Two patients await input from other medical specialities before adalimumab can be prescribed.
18 patients (3.5%) had disease quiescence; thus adalimumab no longer indicated. 2 received a bDMARD from a different medical speciality and 2 lacked funding for adalimumab. 3 uveitics were later found to have a different diagnosis needing a different therapy (e.g. plasma exchange). 9 patients did not proceed to treatment due to patient factors (e.g. patients did not attend their appointments or declined adalimumab).
Of the 464 patients who commenced adalimumab, there were 2 deaths (0.43%); one due to disseminated TB, and one due to cerebral metastasis from a malignant melanoma.
Conclusions :
We describe a screening clinic that assesses the suitability of adalimumab for ocular inflammatory disease patients. We propose that our protocol could be used by ophthalmic colleagues worldwide who wish to prescribe anti-TNF agents for their adult non-infectious uveitis patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.