Outcome of adalimumab monotherapy in paediatric non-infectious uveitis

D A Al-Julandani; N K Bagri; N Tsang; S Clarke; A Upadhyay; C Guly; A V Ramanan

doi:10.1186/s12969-023-00794-y

Outcome of adalimumab monotherapy in paediatric non-infectious uveitis

Pediatr Rheumatol Online J. 2023 Mar 2;21(1):21. doi: 10.1186/s12969-023-00794-y.

Authors

D A Al-Julandani^#¹, N K Bagri^#^{1

2}, N Tsang³, S Clarke^{1

4

5}, A Upadhyay⁶, C Guly⁷, A V Ramanan^{8

9}

Affiliations

¹ Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK.
² Division of Paediatric Rheumatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
³ University of Bristol, Bristol, UK.
⁴ School of Population Health Sciences, University of Bristol, Bristol, UK.
⁵ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
⁶ Scientist II CRU, All India Institute of Medical Sciences, New Delhi, India.
⁷ Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
⁸ Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK. a.ramanan@bristol.ac.uk.
⁹ Translational Health Science, University of Bristol, Bristol, UK. a.ramanan@bristol.ac.uk.

^# Contributed equally.

Abstract

Background: Adalimumab in combination with other disease-modifying antirheumatic drugs (DMARD) such as methotrexate has a proven efficacy in the management of paediatric non-infectious uveitis. However, many children experience significant intolerance to methotrexate while on this combination, leaving a dilemma for clinicians for choosing the subsequent therapeutic roadmap. Continuation of adalimumab monotherapy might be an alternative feasible option under such settings. This study aims to investigate the efficacy of adalimumab monotherapy in paediatric non-infectious uveitis.

Methods: Children with non-infectious uveitis on adalimumab monotherapy (from August 2015 to June 2022) following intolerance to accompanying methotrexate or mycophenolate mofetil were included in this retrospective study. Data were collected at the initiation of adalimumab monotherapy and at three monthly intervals until the last visit. The primary outcome was to evaluate disease control on adalimumab monotherapy as determined by the proportion of patients who had less than a 2-step worsening in uveitis (as per SUN score) and no additional systemic immunosuppression during follow-up. Secondary outcome measures were visual outcome, complications and side-effect profile of adalimumab monotherapy.

Results: Data was collected for 28 patients (56 eyes). The most common uveitis type and course were anterior and chronic uveitis respectively. Juvenile idiopathic arthritis-associated uveitis was the most common underlying diagnosis. During the study period, 23 (82.14%) of the study subjects met the primary outcome. On Kaplan-Meier survival analysis 81.25% (95% CI; 60.6-91.7%) children maintained remission at 12 months on adalimumab monotherapy.

Conclusion: Continuation of adalimumab monotherapy is an effective therapeutic option for the treatment of non-infectious uveitis in children who are intolerant to the combination of adalimumab and methotrexate or mycophenolate mofetil.

Keywords: Adalimumab monotherapy; JIA-uveitis; Non-infectious uveitis; Paediatrics.

MeSH terms

Adalimumab / therapeutic use
Antirheumatic Agents* / therapeutic use
Child
Humans
Methotrexate / therapeutic use
Mycophenolic Acid
Retrospective Studies
Uveitis* / drug therapy

Substances

Adalimumab
Methotrexate
Mycophenolic Acid
Antirheumatic Agents

Abstract

MeSH terms

Substances

Grants and funding