Use of adalimumab in refractory non-infectious childhood chronic uveitis: efficacy in ocular disease--a case cohort interventional study.

OBJECTIVE To assess the use of adalimumab in the treatment of refractory non-infectious childhood chronic uveitis. METHODS A case cohort interventional study was performed on patients with uveitis, who were treated with adalimumab after failure of treatment with a combination of corticosteroids and another immunosuppressant drug. Main outcome measures were (i) stability of vision, (ii) stability of inflammation and (iii) reduction of immunosuppressive load. Adverse events and reasons for stopping adalimumab were noted. RESULTS Seventeen patients from a single regional centre were included in the study. Nine patients had previously received an anti-TNF agent, and because of inefficacy, all were changed to adalimumab. At 12 months, fewer patients had visual acuity worse than LogMAR 0.4 (18% vs 32% at baseline). Using standardized uveitis nomenclature criteria, at 3 months, 50% of the patients eyes (n = 32) had improved, 16% had stable inflammation and 3% had worsened, whereas 31% were maintained with no anterior chamber cells. Six patients required courses of oral steroids for uveitis. Seven patients received intra- or periocular injections of steroids. Adalimumab treatment was interrupted in one patient because of varicella zoster infection. It was stopped in three patients. Seven (41%) patients reported injection site reactions. CONCLUSION In this group of children with refractory uveitis, use of adalimumab was associated with improvement in visual acuity and improving or stable ocular inflammation. However, it did not completely obviate the need for systemic or periocular steroid treatment. Prospective randomized controlled trials are required to help determine which subset of patients may benefit from adalimumab and the duration of treatment.