Adalimumab in Active and Inactive, Non-Infectious Uveitis: Global Results from the VISUAL I and VISUAL II Trials

Rheumatoid arthritis-associated uveitis treated with adalimumab

“…The VISUAL study demonstrated the ability of adalimumab to reduce the risk of recurrent uveitis and vision loss in patients with both active (VISUAL I) and inactive disease (VISUAL II). In both mentioned studies, adalimumab offered significantly better improvement than placebo with fairly comparable risk levels, only slightly higher in adalimumab group (2). The observed adverse effects included susceptibility to infections (reactivation of tuberculosis, histoplasmosis, hepatitis B, and fungal infection), hypersensitivity reactions, demyelinating disease, lupus-like syndrome, malignancy, thromboembolic events, and congestive heart failure (3,7).…”

“…Adalimumab is a recombinant human IgG1 monoclonal antibody targeting the TNF-α. TNF-α is believed to play a crucial role in pathogenesis of non-infectious uveitis, as it both induces and maintains the inflammation in autoimmune response (2,3,5). Whilst adalimumab has well documented efficacy in reducing signs and symptoms of joint involvement in rheumatoid conditions, it also has an effect on ocular involvement, with an additional advantage of subcutaneous dosing (SQ) over other available biological agents which require intravenous injections (2,3,6,7).…”

“…TNF-α is believed to play a crucial role in pathogenesis of non-infectious uveitis, as it both induces and maintains the inflammation in autoimmune response (2,3,5). Whilst adalimumab has well documented efficacy in reducing signs and symptoms of joint involvement in rheumatoid conditions, it also has an effect on ocular involvement, with an additional advantage of subcutaneous dosing (SQ) over other available biological agents which require intravenous injections (2,3,6,7). The meta-analysis for adalimumab efficacy revealed that patients treated with adalimumab had a more favourable outcome proving effective in around 80% of cases (4,5,8).…”

“…It was stated that adalimumab is less likely to generate allergic response, as the molecule is more humanized compared to infliximab. Accordingly, patients with hypersensitivity to infliximab were reported to have achieved remission after switching to adalimumab (2,9). However, the comparison of adalimumab efficacy between treatment-naïve patients and those previously treated with other anti-TNFα agents is unclear and various outcomes have been reported (8,9).…”

“…Established therapy strategy recognises topical steroids as the first line, however chronic or more severe cases demand use of oral steroids or immunosuppressive drugs. For a significant number of patients, disease severity, adverse effects and need for high drug doses facilitate a decision for alternative management (2,4). The most recent addition to the available armamentarium consists of anti-TNF agents.…”