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

To describe the treatment results with adalimumab in chronic paediatric uveitis, not associated with juvenile idiopathic arthritis (JIA).

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.

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.

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.