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Intravitreal adalimumab may be successful when systemic therapy fails
COPENHAGEN — Intravitreal adalimumab may be an “attractive” off-label option for treating breakthrough uveitis in patients on systemic adalimumab therapy, according to Rola Hamam, MD.
At the Euretina meeting, Hamam presented a retrospective review of 13 episodes of treatment failure in seven eyes of four patients treated with intravitreal 1.5 mg adalimumab after treatment failure with 40 mg subcutaneous adalimumab.
Rola Hamam
“All 13 attacks resolved with intravitreal adalimumab treatment without the need to add further measures,” Hamam said.
The mean number of injections needed to resolve each episode was 2.4 over an average of 2.4 months, with three attacks resolving completely after only one injection, according to Hamam. Six attacks required two injections, and four attacks required three injections.
All patients had Behçet’s disease and long-standing uveitis, and all were on systemic adalimumab at the time of the breakthrough inflammation. The mean time that inflammation was controlled before the attack was 4 months.
Resolution of visual acuity was quickest. By 4 weeks, visual acuity had returned to baseline in all four episodes in which visual acuity loss had been recorded. Also at 4 weeks, anterior chamber cells resolved in four of eight attacks, haze resolved in 11 of 12 attacks, and vasculitis resolved in five of seven attacks, but cystoid macular edema remained stable in the two cases in which it was documented.
“The median time to resolution was less than 2 months for the [anterior chamber] cells, vitreous haze and the leakage, but for macular edema it required three injections in both cases,” Hamam said. “We think this is a treatment option that is worth further investigation, especially in patients where other options are not plausible.” – by Patricia Nale, ELS
Reference:
Hamam R. Use of intravitreal adalimumab injections for control of breakthrough uveitis. Presented at: 16th Euretina Congress; Sept. 8-11, 2016; Copenhagen, Denmark.
Disclosure: Hamam reports no relevant financial disclosures.
