Adalimumab for refractory uveitis

The biologic agent adalimumab provides effective control of acute inflammatory activity in most children with steroid-resistant refractory noninfectious uveitis, but the beneficial effects tend to dissipate with time, according to results from a small study.

Researchers from Spain looked at 15 children, most of whom were girls, with a mean age of 12 years. The majority of the subjects had juvenile idiopathic arthritis (JIA); a few had idiopathic uveitis; and one had Blau syndrome (familial juvenile systemic granulomatosis). All the children were previously treated with systemic steroids and methotrexate. Some had also failed treatment with immunosuppressive agents, such as cyclosporine and azathioprine, and with the biologics etanercept and infliximab.

After subcutaneous injection with adalimumab (dosage depended on weight) every 2 weeks for an average of 32 months, the investigators observed improvement of anterior/posterior inflammatory activity in 12 of 14 children, generally after about 6 weeks of treatment. However, the beneficial effects seemed to wane with time.

More specifically, treatment was deemed effective in 9 patients (60%), mildly effective in 2 (13%), ineffective in 2 (13%), and resulted in worsening in 2 (13%). Looking at only the children with JIA, treatment was effective in 6 (60%), mildly effective in 2 (20%), and ineffective in 2 (20%). The investigators observed only minor side effects at the injection site.

Although topical steroids remain an important component of therapy, experts hope that systemic therapies will help simultaneously control both joint and eye disease associated with conditions like JIA.

Adalimumab is a recombinant human IgG1 monoclonal antibody to TNF-α.

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