Uveitis: Pediatric Patients Did Fine on Adalimumab

Adalimumab has the potential to serve an important role in management of chronic and refractory noninfectious uveitis and associated macular edema with low rates of serious adverse events in the long term, according to a recent report. That includes pediatric patients.

The paper, written by Stephanie Engelhard, BA, a medical student in the department of Ophthalmology at the University of Virginia, Charlottesville, and colleague, appeared in the October issue of Retina Today.

In a study of 18 pediatric patients, 17 of whom had JIA-associated uveitis, adalimumab was found to be either very or moderately effective in 88% of patients. In that study, although rates of success for treatment of arthritis were similar among three drugs (adalimumab, infliximab, and etanercept), adalimumab was more effective in treating uveitis than the other two drugs. Other reports echo these findings. In order to systematically study the cost-effectiveness and efficacy of adalimumab in treating uveitis in patients with JIA, the randomized, controlled SYCAMORE trial is now enrolling patients in the United Kingdom.

Adalimumab has shown promise in the treatment of uveitis associated with Behçet disease and AS. In a case series of three patients with bilateral panuveitis secondary to Behçet disease, in all three patients adalimumab maintained disease remission and prevented relapse when other drugs, including infliximab, failed to do so. Results were similar in a larger study of 124 patients with Behçet disease. Similarly, studies have reported a decrease in AS-associated uveitis flares and decreased disease burden with adalimumab treatment.

Overall, available data suggest that adalimumab has the potential to serve an important role in management of chronic and refractory noninfectious uveitis and associated macular edema with low rates of serious adverse events in the long term. The recent FDA approval of adalimumab for the treatment of uveitis stands to benefit many patients; however, additional long-term, sufficiently powered, randomized controlled trials must be conducted to further evaluate the drug’s effectiveness, cost-efficiency, and safety relative to other immunosuppressive therapies in distinct uveitis subpopulations in a systematic manner.

“There is not a suggested monitoring schedule that is superior to others,” said Engelhard. “In general, obtaining metabolic panels, liver function tests, and complete blood counts every one to two months or as needed is suggested. The use of any anti—TNF-α agent requires heightened vigilance against the development of infections and especially the reactivation of tuberculosis.”

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