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Treatment of pediatric uveitis with adalimumab: the MERSI experience
Claudia Castiblanco1, Halea Meese1, C Stephen Foster2
1Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation (OIUF), Waltham, Massachusetts.
Insights
Adalimumab therapy effectively induced steroid-free remission in pediatric uveitis patients, demonstrating good tolerability, particularly when combined with other immunomodulatory agents. Dosing adjustments can further enhance inflammation control.
Area of Science:
- Ophthalmology
- Rheumatology
- Pediatrics
Background:
- Uveitis in children can lead to significant vision impairment.
- Adalimumab is a biologic agent used to treat inflammatory conditions.
Purpose of the Study:
- To evaluate the efficacy and safety of adalimumab therapy in pediatric patients with uveitis.
Main Methods:
- Retrospective review of electronic health records for pediatric uveitis patients treated with adalimumab.
- Data collected included demographics, inflammation characteristics, visual acuity, comorbidities, treatment duration, side effects, and remission rates.
Main Results:
- 17 pediatric patients with uveitis were included; 13 (77%) achieved steroid-free remission.
- Adalimumab was generally well-tolerated, with side effects including injection site pain, anemia, and depression.
- 11 patients achieved an inflammation-free state at 1-year follow-up, with combination therapy showing sustained control.
Conclusions:
- Adalimumab is effective in achieving steroid-free remission in pediatric uveitis.
- The drug is well-tolerated, especially when used with other immunomodulatory agents.
- Optimizing dosing and interval may further improve inflammation management.
Purpose:
To evaluate adalimumab therapy in children with uveitis.
Methods:
The electronic health records of pediatric patients diagnosed with uveitis and treated with adalimumab therapy were reviewed retrospectively. Demographic information, site and degree of intraocular inflammation, visual acuity, underlying systemic disorders, duration of therapy, side effects, and ability to obtain steroid-free remission were recorded.
Results:
A total of 17 patients were included, 16 patients with anterior uveitis and 1 with panuveitis; 14 patients had bilateral disease. Juvenile idiopathic arthritis had been diagnosed in 14 patients, sarcoidosis in 1 patient, and idiopathic etiology in 2 patients. Of the 17 patients, 13 (about 77%) achieved steroid-free remission, and 4 did not. Six patients flared after discontinuation of adalimumab, with evidence of inflammation noted 3-7 months later. Adalimumab therapy was of 12-64 months' duration (mean, 36 months). At the time of initiation, 14 patients were using other agents concomitantly with adalimumab; 3 patients were on adalimumab monotherapy. At 1 year's follow-up, 12 patients were using combination therapy, and 3 patients were on adalimumab monotherapy: 11 patients had no evidence of inflammation. Side effects included pain at site of injection in 3 patients, anemia in 1 patient, and depression in 1 patient.
Conclusions:
In our study cohort, adalimumab was effective in inducing steroid-free remission. It was well tolerated, especially in combination with other immunomodulatory agents. The dosing and the interval can be adjusted to further improve inflammation control.
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