Adalimumab appears effective in refractory uveitis

This large retrospective study found that adalimumab was effective in 82 percent of patients with refractory uveitis.

Adalimumab could be of benefit for those who are refractory to steroids. The limiting factor of this study is its retrospective design. Future clinical trials could help confirm the findings.

The authors reviewed the charts of 60 patients with an average age of 37.3 years (range 4 to 71 years) treated with adalimumab and followed for an average of 87.9 weeks at three different centers. Treatment indication was both uveitis and systemic disease in 68.3 percent of patients and uveitis only in 31.7 percent.

All patients had been given other immunosuppressive treatment with insufficient response before the initiation of adalimumab, including 25 percent treated with etanercept and 16.7 percent with infliximab in the customary doses.

Efficacy was based on reduction of macular edema by optic coherence tomography, visual acuity, anterior chamber cells, reduction of frequency of flares and reduction of prednisone dose during the treatment. At least one of the criteria had to be improved and none worsened to declare treatment effective.

Improvement in one or more of the outcome measures and worsening in none was seen in 81.7 percent of patients. The remaining 18.3 percent did not meet the improvement criteria and were given additional or alternative immunosuppressive treatment. At the last follow-up, 78.3 percent of all patients were still being treated with adalimumab; 21.6 percent of patients stopped adalimumab due to inefficacy (eight patients), side effects of liver enzyme elevation and furunculosis (three patients), pregnancy (one patient) and death (one patient).