• By John D. Sheppard, MD, MMSc

    This prospective study found that the use of adalimumab appears to improve visual acuity and ocular inflammation in patients with refractory noninfectious childhood chronic uveitis. Nevertheless, it did not eliminate the need for adjunctive oral or injection steroid treatment.

    The subjects were 17 patients from a single regional center who received adalimumab after failure of treatment with a combination of corticosteroids and another immunosuppressant drug. Nine of these patients had previously received another anti-TNF agent and because of inefficacy were switched to adalimumab.

    At 12 months, 18 percent of patients had visual acuity worse than logMAR 0.4 compared with 32 percent at baseline. At three months, 50 percent of eyes had improved, 16 percent had stable inflammation, 3 percent had worsened, and 31 percent were maintained with no anterior chamber cells.

    Six patients required oral steroids. Adalimumab treatment was interrupted in one patient because of varicella zoster infection, and stopped in three patients. Seven patients reported injection site reactions.

    The authors conclude that prospective randomized controlled trials should help further characterize clinical responses in this important patient subset.