Elsevier

Ophthalmology

Volume 119, Issue 8, August 2012, Pages 1575-1581
Ophthalmology

Original article
Treatment of Refractory Uveitis with Adalimumab: A Prospective Multicenter Study of 131 Patients

Presented in part as a poster at: the Annual Meeting of the Association for Research in Vision and Ophthalmology, May 2–6, 2010, Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2012.02.018Get rights and content

Objective

To evaluate adalimumab therapy in refractory uveitis.

Design

Prospective case series.

Participants

A total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated.

Intervention

Patients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6).

Main Outcome Measures

Degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thickness (optical coherence tomography).

Results

There were 61 men and 70 women (mean age, 27.3 years). The most common causes were juvenile idiopathic arthritis in 39 patients, pars planitis in 16 patients, and Behçet's disease in 13 patients. Twenty-seven patients had uveitis of idiopathic origin. Inflammation in the anterior chamber was present in 82% of patients and in the vitreous cavity in 59% of patients. Anterior chamber inflammation and vitreous inflammation decreased significantly (P < 0.001) from a mean of 1.51 and 1.03 at baseline to 0.25 and 0.14, respectively, at 6 months. Macular thickness was 296 (102) μ at baseline versus 240 (36) μ at the 6-month visit (P < 0.001). Visual acuity improved by −0.3 logMAR in 32 of 150 eyes (21.3%) and worsened by +0.3 logMAR (−15 letters) in 5 eyes (3.3%). The dose of corticosteroids also decreased from 0.74 (3.50) to 0.20 (0.57) mg/kg/day (P < 0.001). Cystoid macular edema, which was present in 40 eyes at baseline, showed complete resolution in 28 eyes at 6 months. The mean suppression load decreased significantly (8.81 [5.05] vs 5.40 [4.43]; P < 0.001). Six months after the initiation of the study, 111 patients (85%) were able to reduce at least 50% of their baseline immunosuppression load. Only 9 patients (6.9%) had severe relapses during the 6 months of follow-up.

Conclusions

Adalimumab seems to be well tolerated and helpful in decreasing inflammatory activity in refractory uveitis and may reduce steroid requirement. Further controlled studies of adalimumab for uveitis are warranted.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Design and Enrollment Criteria

A prospective open-label noncomparative and multicenter study was conducted in the outpatient clinics of the Services of Ophthalmology or Uveitis Units of 12 centers throughout Spain and 2 centers in Latin America (Mexico, DF, Mexico, and Caracas, Venezuela) in daily practice conditions. The objective of the study was to evaluate adalimumab for treating patients with bilateral or unilateral, chronic, noninfectious, refractory uveitis. Uveitis was defined as refractory when patients were

Discussion

This is a prospective adalimumab treatment study in a large clinical series of 131 patients, and this anti–TNF-α agent seems to be an effective and well-tolerated treatment for patients with chronic, therapy-resistant, noninfectious uveitis. The effectiveness of adalimumab was demonstrated by a statistically significant decrease of anterior chamber and vitreous cavity inflammation, overall gain in visual acuity, reduction of macular thickness, and decrease of the immunosuppression load. In

Acknowledgment

The authors thank Marta Pulido, MD, for writing assistance and extensive editing of the scientific content.

References (32)

  • M.D. Becker et al.

    The role of T cells in autoimmune uveitis

    Ocul Immunol Inflamm

    (2000)
  • S.R. Taylor et al.

    New developments in corticosteroid therapy for uveitis

    Ophthalmologica

    (2010)
  • P.I. Murray et al.

    Anti-TNF-alpha therapy for uveitis: Behçet and beyond

    Eye (Lond)

    (2005)
  • M. Santos Lacomba et al.

    Aqueous humor and serum tumor necrosis factor-alpha in clinical uveitis

    Ophthalmic Res

    (2001)
  • V. Pérez-Guijo et al.

    Tumour necrosis factor-alpha levels in aqueous humour and serum from patients with uveitis: the involvement of HLA-B27

    Curr Med Res Opin

    (2004)
  • C.E. Rabinovich

    Use of tumor necrosis factor inhibitors in uveitis

    Curr Opin Rheumatol

    (2007)

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    Manuscript no. 2011-1035.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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