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Efficacy of adalimumab in pediatric non-infectious uveitis with and without anterior segment inflammation
Chunbo Zhang1, Xiaorong Xue1, Jinan Xiao2
1Department of Pharmacy, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University, Xi'an, 710004, China.
Insights
Adalimumab (ADA) is more effective for pediatric non-infectious uveitis with anterior segment inflammation (ASI+). Patients with ASI+ showed significantly higher treatment success rates and improved visual acuity compared to those without ASI-.
Area of Science:
- Ophthalmology
- Immunology
- Pediatrics
Background:
- Pediatric non-infectious uveitis poses a significant challenge in maintaining ocular health and visual function.
- Adalimumab (ADA) is an established biologic therapy, but its efficacy across different uveitis phenotypes requires further elucidation.
Purpose of the Study:
- To investigate the clinical characteristics associated with the treatment response rate of adalimumab (ADA) in pediatric non-infectious uveitis.
- To compare the efficacy of ADA in patients with anterior segment inflammation (ASI+) versus those without (ASI-).
Main Methods:
- Retrospective review of medical records for pediatric patients with non-infectious uveitis treated with ADA for at least six months.
- Stratification of patients into ASI+ and ASI- groups.
- Assessment of treatment success rate, best-corrected visual acuity (BCVA), inflammation parameters, RNFL thickness, FA scores, and medication load.
Main Results:
- The study included 59 patients (111 eyes); 74.58% had ASI+ and 25.42% had ASI-.
- Treatment success rate was significantly higher in the ASI+ group (93.18%) compared to the ASI- group (20%, p < 0.001).
- ASI+ patients showed significant improvements in BCVA, inflammation, RNFL, and FA scores after 6 months of ADA treatment, unlike ASI- patients. Both groups experienced reduced systemic immunosuppression and glucocorticoid use.
Conclusions:
- Adalimumab (ADA) demonstrates superior efficacy in treating pediatric non-infectious uveitis patients with anterior segment inflammation (ASI+).
- The findings support the use of ADA as a targeted therapy for pediatric uveitis, particularly in cases with ASI+.
Background:
This study aimed to identify the clinical characteristics of cases that is related to the response rate of adalimumab (ADA) treatment.
Methods:
A retrospective review of medical records was conducted for pediatric patients with non-infectious uveitis undergoing ADA treatment for a minimum of six months. The patients were stratified into two groups: those with anterior segment inflammation (ASI+) and those without anterior segment inflammation (ASI-). The primary outcome was treatment success rate. Secondary outcomes including best-corrected visual acuity (BCVA), inflammation parameters [anterior chamber cell (ACC), vitreous haze (VH)], retinal nerve fiber layer (RNFL) thickness, fluorescein angiography (FA) scores, as well as systemic immunosuppression therapy (IMT) and glucocorticoid load, were assessed.
Results:
The study included 59 patients (111 eyes), with 44 patients (83 eyes, 74.58%) falling into the ASI + group and 15 patients (28 eyes, 25.42%) in the ASI- group. The treatment success rate in the ASI + group was significantly higher than in ASI- patients (93.18% vs. 20%, p < 0.001). Following 6-month of ADA treatment in the ASI + group, there was a significant improvement in BCVA (p < 0.001), inflammation parameters (p < 0.001), reduced RNFL thickness and reduced FA scores (p < 0.001). Conversely, no significant differences were observed in BCVA, inflammation parameters, RNFL thickness and FA scores in the ASI- group. There was also a significant decrease in systemic IMT and glucocorticoid dosing, comparing baseline to the 6-month follow-up visit in both the ASI+ (p < 0.001) and ASI- groups (p < 0.05). Adverse events observed during the study period included abdominal pain, skin erythema, articular symptoms and respiratory infections.
Conclusion:
ADA demonstrates superior efficacy in the treating pediatric non-infectious uveitis with ASI + compared to ASI-.
