Adalimumab: viable treatment option for pediatric refractory uveitis?

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Abstract

Non-infectious childhood uveitis, with its chronic nature, has the potential for long-term complications and possible blindness. Although strongly associated with an underlying autoimmune systemic disease like juvenile idiopathic arthritis, a significant number of cases are idiopathic. Treatment protocols for pediatric uveitis start with steroids as their safety profile is well known, but their associated systemic and ocular complications, especially in children, rule out their long -term use. Immunosuppressives have been used as second step for control and maintenance, but they have significant side effects and limited efficacy in recalcitrant cases. Therefore, treatment options have been extended to TNF-α inhibitors such as infliximab and adalimumab which have shown good success in patients not responding to immunosuppressives. Significantly, a waning off of clinical efficacy has been observed in patients with chimeric biologics like infliximab. Adalimumab, a fully humanized antibody, has shown promise in treating refractory cases of systemic, as well as intraocular, inflammation. In recent years, its use has been extended to childhood refractory uveitis. It offers several advantages over infliximab including easier administration, cost-effectiveness, better patient compliance and a lower rate of adverse events. This review analyzes the clinical and pharmacological features of adalimumab and its role in refractory pediatric uveitis.

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