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Adalimumab more effective as first-line anti-TNF-a therapy for uveitis
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Adalimumab had better efficacy when used as the first anti-tumor necrosis factor-alpha treatment for childhood chronic uveitis than when used after infliximab failed, according to study results.
In an open-label, multicenter study, Italian researchers evaluated 26 patients (median age, 8.6 years; 14 female) with resistant, noninfectious active uveitis. The children were enrolled in two treatment groups, due to the refractory course of uveitis to previous disease-modifying antirheumatic drugs. Fourteen children (group 1; 10 with juvenile idiopathic arthritis (JIA), three with idiopathic uveitis and one with Behçet’s syndrome) received adalimumab (24 mg/m2, every 2 weeks) as first anti-tumor necrosis factor-alpha (anti-TNF-a) treatment.
Twelve children (group 2; seven with JIA, three with idiopathic uveitis, one with early-onset sarcoidosis and one with Behçet’s syndrome) received adalimumab as a second anti-TNF-a therapy, due to loss of efficacy of infliximab, given for at least 1 year at 5 mg/kg to 10 mg/kg at weeks 0, 2 and 6, then every 6 to 8 weeks.
Adalimumab was administered as treatment for at least 1 year to both groups. Time to first relapse after achieving remission was the primary outcome.
During the first 12 months of treatment, group 2 displayed a lower probability to steroid discontinuation (Mantel-Cox chi-square 4.12; P<.004). A higher probability of uveitis remission was experienced by group 1 patients in a long-term follow-up (median ± SE: 18 ± 1.1 months vs. 4 ± 0.6 months; 95% CI, 15.6-27.5 vs. 2.7-5.2).
“The present comparative prospective study … might suggest clinicians to consider adalimumab as a potential starting option in case of childhood chronic refractory uveitis,” the researchers concluded. “Further studies in a larger cohort, in a prospective fashion, preferably by a randomized clinical trial, focused on one disease entity with a sufficient samples size, seem to be advocated to address this point.”
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