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Adalimumab for the treatment of refractory active and inactive non-infectious uveitis
  1. Jonathan TL Lee1,
  2. William B Yates2,3,
  3. Sophie Rogers1,
  4. Denis Wakefield4,
  5. Peter McCluskey2,3,
  6. Lyndell L Lim1,5
  1. 1 Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
  2. 2 Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
  3. 3 Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
  4. 4 School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
  5. 5 Ocular Immunology Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  1. Correspondence to Associate Professor Lyndell L Lim, Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia; limllp{at}unimelb.edu.au

Abstract

Background/aims To compare the efficacy of adalimumab in eyes with active and inactive non-infectious uveitis in the real-world setting.

Methods Multicentre, retrospective, chart review of patients with refractory non-infectious uveitis treated with adalimumab. Main outcome measures included reduction of prednisolone dose, ability to taper immunosuppressives and a composite endpoint of treatment failure encompassing active inflammatory chorioretinal or retinal vascular lesions, intraocular inflammation grade and visual acuity.

Results Thirty-seven eyes of 22 patients were studied. Mean follow-up was 20.1 months (median: 13). Most had either posterior or panuveitis (n=12, 55%). Mean duration of uveitis at baseline was 83.2 months (median: 61), where the majority (n=15, 68%) had already been treated with two or more conventional immunosuppressive agents in addition to prednisolone. Oral prednisolone was reduced to ≤10 mg/day in 9 of 12 patients (75%) by 6 weeks. At 6 months of therapy, nine (90%) of the active eyes achieved a 2-step improvement in anterior chamber inflammation, with six (60%) demonstrating a similar improvement in vitreous haze grade. Almost all (n=17, 94%) of the initially inactive eyes maintained clinical quiescence at this time point. The incidence rate of treatment failure during follow-up was 88 per 100 eye-years for the active eyes and 24 per 100 eye-years for the initially inactive eyes. There were no serious adverse effects.

Conclusion Adalimumab appears to reduce the corticosteroid burden in active and inactive non-infectious uveitis in the real-world setting. Inflammatory activity at the time of adalimumab commencement may determine long-term treatment success.

  • Inflammation
  • Adalimumab
  • Uveitis
  • Ophthalmology
  • Tumor Necrosis Factor-alpha
  • Retrospective Studies
  • Chronic Disease
  • Adult
  • Child
  • Humans
  • Treatment Outcome
  • Treatment Failure
  • antibodies
  • monoclonal
  • humanised

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Footnotes

  • Contributors All authors made significant contributions to this paper and approved the final version to be published.

  • Funding LLL is supported by a National Health & Medical Research Council Early Career Fellowship (#1109330). Centre for Eye Research Australia receives Operational Infrastructure Support from the Victorian Government in Australia.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Royal Victorian Eye and Ear Hospital Human Research Ethics Committee and the South East Sydney local health district Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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