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Adalimumab Dose Reduction and Withdrawal in Stable Non-Infectious Pediatric Uveitis: An Open-Label, Prospective,

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Summary

Reducing or stopping adalimumab (ADA) in children with stable pediatric non-infectious uveitis (PNIU) led to a high risk of inflammation recurrence. Reinstating ADA at its last effective dose frequency helped regain disease control.

Keywords:
Adalimumabadalimumab serum drug leveldose reduction and withdrawalpediatric non-infectious uveitisrelapse-free survival rate

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Area of Science:

  • Ophthalmology
  • Immunology
  • Pediatrics

Background:

  • Pediatric non-infectious uveitis (PNIU) requires long-term management, often with biologic agents like adalimumab (ADA).
  • Optimizing ADA treatment strategies, including dose reduction and withdrawal, is crucial for managing PNIU in children while minimizing treatment burden and potential side effects.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of a dose reduction and withdrawal strategy for adalimumab in children with stable PNIU.
  • To assess the risk of inflammation recurrence and the effectiveness of resuming ADA treatment after dose modification or discontinuation.

Main Methods:

  • An open-label prospective pilot trial involving 18 stable PNIU patients (aged 2-18 years) treated with ADA and methotrexate.
  • Patients initially had their ADA interval extended from 2 to 4 weeks, followed by complete withdrawal if stable, with follow-up for 48 weeks.
  • Key outcomes included relapse-free survival, visual acuity, ocular inflammation markers (anterior chamber cells, vitritis), macular thickness, and serum ADA levels.

Main Results:

  • A significant relapse rate was observed: 33.3% during dose reduction (ADA every 4 weeks) and 44.5% after withdrawal.
  • Only 22.2% of patients remained relapse-free at 48 weeks; successful withdrawal occurred in 4 patients, all diagnosed with Behçet's disease (BD).
  • While visual acuity and macular thickness remained stable, ocular inflammation markers (anterior chamber cells, vitritis) showed an increasing trend; serum ADA levels decreased over time.

Conclusions:

  • Dose reduction and withdrawal of adalimumab in stable PNIU patients carries a high risk of recurrent inflammation.
  • Resuming adalimumab at the last effective dosage frequency can effectively control inflammation.
  • Monitoring serum ADA levels in patients experiencing recurrence may aid in determining optimal dosing intervals.