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Primed Mycobacterial Uveitis PMU as a Model for Post-Infectious Uveitis

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Recurrence Risk in Pediatric Noninfectious Uveitis During Adalimumab Tapering: An International Multicenter

Achille Marino¹, Maria Vittoria Cicinelli², Elisabetta Miserocchi²

¹ASST Gaetano Pini-CTO, Milan, Italy.

Arthritis & Rheumatology (Hoboken, N.J.)

|April 2, 2025

Summary

A slower tapering of adalimumab (ADA) reduces noninfectious uveitis (NIU) relapse risk in pediatric patients. Gradual dose reduction and close monitoring are recommended for managing NIU during ADA tapering.

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Area of Science:

Ophthalmology
Rheumatology
Pediatrics

Background:

Noninfectious uveitis (NIU) is a significant cause of vision loss in children.
Adalimumab (ADA) is an effective biologic therapy for pediatric NIU.
Tapering ADA requires careful consideration to prevent disease relapse.

Purpose of the Study:

To assess the risk of NIU relapse in pediatric patients during adalimumab (ADA) tapering.
To identify predictors of NIU recurrence during ADA dose reduction.

Main Methods:

Multicenter retrospective cohort study of pediatric NIU patients undergoing ADA tapering.
Cox proportional hazards regression analysis to determine risk factors for NIU recurrence.

Main Results:

46% of patients experienced NIU recurrence during ADA tapering.
A slower ADA tapering schedule was associated with a significantly lower recurrence rate (HR 0.40).
For juvenile idiopathic arthritis-associated uveitis (JIA-U), initiating ADA tapering after two years of inactivity reduced recurrence risk (HR 0.65).

Conclusions:

Adalimumab (ADA) tapering significantly impacts uveitis recurrence risk in pediatric patients.
A gradual, slow-tapering approach for ADA is recommended.
Close patient monitoring is crucial during and after ADA tapering to manage NIU recurrence.