Evaluate the mid-term efficacy and safety of adalimumab in the pediatric population with severe uveitis.Methods
We retrospectively analysed 18 children with severe uveitis, who were treated with adalimumab (20 or 40 mg every two weeks) when the previous immunosuppressive therapy has been ineffective. It consisted of systemic corticosteroids (n=18), methotrexate (n=18), azathioprine (n=8), infliximab (n=6), etanercept (n=6), interferon-alpla (n=1). Primary outcome was to assess laser flare photometry values after adalimumab therapy compared with baseline. Clinical features (SUN criteria, macular edema and papillitis), oral prednisone threshold, visual acuity, side effects and complications of treatment were also considered.Results
Median age was 13.1 years (range 6-20.8),sex ratio (F/M) was 3. Median duration before adalimumab therapy was 82.6 months (range 16-262). The mean follow-up was 35.5 months (range 23-63) and the final median laser flare photometry value was significantly reduced from 149.5 ph/ms (range 24-335) to 81.3 ph/ms (range 4-224) p<0.005. Median oral prednisone decreased from 10.3 mg/day (range 0-30) to 1.7 mg/day (range 0-15) p<0.05. Uveitis was controlled in 10 cases (55.5%). Relapses occurred in 2 cases (11%), adalimumab was ineffective in 3 cases (17%) and was stopped in one patient who had excellent control of inflammation. Three children (17%) discontinued treatment due to severe side effects.Conclusion
Adalimumab appears to be an effective and well tolerated treatment for refractory pediatric uveitis, with prolonged control of inflammation over several years, even after failure of other anti-TNF alpha agents. A prospective randomized double blind study is ongoing.