Clinical benefits and potential risks of adalimumab in non‐JIA chronic paediatric uveitis

Abstract

Purpose To describe the treatment results with adalimumab in chronic paediatric uveitis, not associated with juvenile idiopathic arthritis (JIA). Methods Medical records of children with non‐JIA‐uveitis were reviewed retrospectively. Children without an underlying systemic disease were pre‐screened with brain magnetic resonance imaging (MRI) to exclude white matter abnormalities/demyelination. Results Twenty‐six patients were pre‐screened with brain MRI, of whom adalimumab was contraindicated in six patients (23%) with non‐anterior uveitis. Forty‐three patients (81 eyes) were included. Disease inactivity was achieved in 91% of the patients after a median of three months (3–33). Best‐corrected visual acuity (BCVA) improved from 0.16 ± 0.55 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.05 ± 0.19 logMAR at 24 months (p = 0.015). The median dosage of systemic corticosteroids was reduced to 0 mg/day at 24 months of follow‐up (versus 10 mg/day at baseline; p < 0.001). Adalimumab was discontinued in thirteen children due to ineffectiveness (n = 8), side effects (n = 1), long‐term inactivity of uveitis (n = 3) or own initiative (n = 1). Relapse of uveitis occurred in 19 (49%) patients, 5 (26%) of them without an identifiable cause. Conclusion Adalimumab is effective in the treatment of non‐JIA‐uveitis in paediatric patients by achieving disease inactivity in the majority of the patients, improving BCVA and decreasing the dose of corticosteroids. Adverse events and side effects are limited. Pre‐screening with MRI of the brain is recommended in paediatric patients with intermediate and panuveitis.

The Efficacy of Adalimumab in Children with Chronic Non-infectious Posterior Uveitis and Panuveitis: A Retrospective Cohort Study

“…Our study demonstrated that ADA was effective in children with chronic posterior uveitis and panuveitis, with 90.6% attaining remission after 3 months, which was consistent with previous studies [ 3 , 21 ] including anterior uveitis cases. In our study, 46 eyes achieved symptom alleviation without relapse during follow-up.…”

“…The rates of achievement of the inactive state and success were 23.3% and 46.5%, respectively, during 1 year of treatment with ADA or infliximab. Kouwenberg et al [ 3 ] demonstrated that treatment with ADA led to prompt inactivity of non-JIA uveitis in the majority of children (90.6%), whereas this study included 15 (35%) and eight (18.6%) patients with anterior and intermediate uveitis, respectively. Another study that included the largest number of panuveitis cases (28 patients, 90%) demonstrated that anterior and posterior inflammation reached inactivity after 4 weeks in all cases [ 21 ].…”

“…Systemic JIA was one of the most common causes of pediatric uveitis and the only FDA-approved disease for which ADA could be administered in children before 2018, studies on the effectiveness of ADA have focused on pediatric anterior uveitis associated with JIA, such as the SYCAMORE and ADJUVITE RCTs [ 19 , 20 ]. After ADA was approved for patients aged > 2 years with uveitis, a small number of studies further supported the use of ADA in children [ 3 , 4 , 21 ]. Deitch et al [ 4 ] first studied the effects of anti-TNF-α agents on outcomes of pediatric uveitis of diverse types, including 20 (46.5%) cases of panuveitis.…”

“…A total of 52.1% of patients treated with ADA experienced at least one relapse during follow-up, although this was fewer than the number of relapses in patients treated with CT (90.5%). Uveitis relapse occurred in five (26%) patients without an identifiable cause and in 14 (33%) with an identifiable cause in a similar retrospective study of patients with non-JIA chronic uveitis [ 3 ]. However, the reason for flare-ups following ADA therapy remains unclear.…”

“…The most commonly identified cause of pediatric uveitis is juvenile idiopathic arthritis (JIA), presenting mostly as anterior uveitis. However, few studies have focused on non-JIA uveitis [ 3 , 4 ]; moreover, research on improving treatment options for pediatric posterior uveitis or panuveitis is lacking, which is often chronic, persistent, and threatens vision.…”