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Adalimumab Monotherapy or Combination Therapy With Methotrexate in Paediatric Uveitis: Data From the AIDA Network

Carla Gaggiano1, Alejandra de-la-Torre2, Silvana Guerriero3

  • 1Rheumatology Unit, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena University Hospital [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy.

Clinical & Experimental Ophthalmology
|April 4, 2025
PubMed

Insights

Adalimumab (ADA) monotherapy is as effective as combination therapy with methotrexate (MTX) for treating pediatric noninfectious uveitis (NIU). Both treatments reduce relapses and preserve visual acuity, with similar long-term retention rates.

Area of Science:

  • Ophthalmology
  • Immunology
  • Pediatrics

Background:

  • Pediatric noninfectious uveitis (NIU) requires effective treatment to prevent vision loss.
  • Adalimumab (ADA) is a biologic agent used for NIU, but its optimal use (monotherapy vs. combination therapy) is under investigation.

Purpose of the Study:

  • To compare the effectiveness of adalimumab (ADA) monotherapy versus ADA in combination with methotrexate (MTX) for treating pediatric noninfectious uveitis (NIU).

Main Methods:

  • A registry-based observational study included children with active NIU treated with ADA.
  • Patients were divided into two groups: ADA monotherapy and ADA plus MTX combination therapy.
  • Effectiveness was assessed by uveitis control, relapse rates, visual acuity, and steroid-sparing effects.

Main Results:

  • Eighty-four children were analyzed, with 22 in the ADA monotherapy group and 62 in the ADA plus MTX group.
  • Overall effectiveness (complete, partial, absent) did not differ significantly between groups (p=0.89).
  • Both treatment strategies significantly reduced uveitis relapses and demonstrated a steroid-sparing effect, with comparable final visual acuity and ADA retention rates up to 36 months.

Conclusions:

  • Adalimumab monotherapy appears to be as effective as combination therapy with methotrexate in managing pediatric NIU.
  • Both approaches show comparable efficacy in preventing relapses, preserving visual acuity, and maintaining treatment adherence.
  • Further research is needed to fully define the role of ADA monotherapy in the therapeutic strategy for pediatric NIU.
Abstract

Keywords:
adalimumabmethotrexatemonotherapynoninfectious uveitispaediatric ophthalmology

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