Treatment of a Large Cohort of Childhood Chronic Noninfectious Uveitis in a Multicentric Large Study: Adalimumab Versus Methotrexate as First-Line Therapy

Treatment of childhood chronic idiopathic uveitis (cCIU) is predominantly based on studies in juvenile idiopathic arthritis-associated uveitis and expert opinion. Our aim was to report the treatment outcomes of our cohort of cCIU.

Retrospective multicenter study involving the rheumatology and ophthalmology units at Florence, Italy, and Bristol, United Kingdom. We included children with cCIU, who received at least one systemic treatment. Ocular inflammation and treatment response were assessed according to the standardized uveitis nomenclature.

A total of 116 patients with cCIU received at least one systemic treatment (93 methotrexate, 22 adalimumab, and 1 mycophenolate), whereas 60 of them received an additional second-line treatment (45 adalimumab, 14 mycophenolate, and 1 tocilizumab). Children treated with adalimumab (plus or minus methotrexate) as a first-line therapy were more likely to achieve remission than methotrexate alone (χ² = 31.35; P < 0.001); furthermore, children treated with methotrexate as a first-line therapy relapsed earlier (χ² = 4.35; P = 0.043). Children receiving adalimumab were more likely to stop treatment for remission than methotrexate (χ² = 25.9; P < 0.001). Regarding second-line therapy, children who started adalimumab (plus or minus methotrexate) were more likely to achieve remission than mycophenolate (χ² = 14.66; P = 0.005). Children with nonanterior uveitis, conversely to the others, were more likely to achieve remission with adalimumab as a first-line therapy than methotrexate (χ² = 32.3; P < 0.001). Children with nonanterior uveitis, but not children with anterior uveitis, were more likely to stop the first-line treatment when receiving adalimumab than methotrexate (χ² = 18.56; P = 0.001) due to persistent remission.

Adalimumab shows promise as a potential first-line therapy for cCIU, particularly for posterior segment uveitis. Although effective in anterior uveitis, methotrexate leads children to relapse earlier than adalimumab.