Intravitreal versus Subcutaneous Adalimumab in Active Non-Infectious Uveitis: A Randomized Non-Inferiority Trial.

Area of Science:

• Ophthalmology
• Immunology
• Clinical Trials

Background:

• Non-infectious uveitis (NIU) is a significant cause of vision loss.
• Adalimumab is an effective treatment for NIU, but administration routes vary.
• Comparing subcutaneous adalimumab (SCA) and intravitreal adalimumab (IVA) is crucial for optimizing NIU management.

Purpose of the Study:

• To compare the clinical effectiveness and safety of subcutaneous adalimumab (SCA) versus intravitreal adalimumab (IVA) in patients with active non-infectious uveitis (NIU).

Main Methods:

• A single-center, phase 2 non-inferiority randomized controlled trial was conducted.
• Patients received either SCA (80 mg loading dose, then 40 mg every 2 weeks) or IVA (1.5 mg every 4 weeks).
• Primary outcomes included changes in anterior chamber cell and vitreous haze grades at 26 weeks; secondary outcomes assessed visual acuity, retinal thickness, and adverse events.

Main Results:

• Intravitreal adalimumab (IVA) was found to be non-inferior to subcutaneous adalimumab (SCA) in treating active NIU.
• No significant differences were observed in anterior chamber cell or vitreous haze grade changes between the groups.
• IVA showed a comparable safety profile with fewer non-serious systemic adverse events compared to SCA.

Conclusions:

• Intravitreal adalimumab (IVA) is a viable and effective alternative to subcutaneous adalimumab (SCA) for managing active non-infectious uveitis (NIU).
• IVA offers a potentially improved safety profile by reducing systemic adverse events.
• Further research may explore long-term outcomes and patient-reported benefits of IVA in NIU.