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  • Findings on Brain MRI Scans May Predict Demyelination in Patients with NIU

    Neuro-Ophthalmology/Orbit, Uveitis

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    Review of: Predictive factors for magnetic resonance imaging changes suggestive of demyelination in adult patients with uveitis scanned prior to commencing adalimumab therapy

    Sanghi P, Luis J, Ajamil S, et al. Ocular Immunology and Inflammation, September 2023

    Investigators conducted a retrospective case series study to determine which clinical factors of noninfectious uveitis (NIU) were predictive of magnetic resonance imaging (MRI) abnormalities consistent with a diagnosis of demyelination. Determining the presence of demyelination is important when considering adalimumab treatment.

    Study Design

    Two hundred thirty-eight patients with NIU who were seen at Moorfields Eye Hospital prior to starting adalimumab therapy were included in the study. All patients had posterior segment–involving disease.

    Outcomes

    One hundred two of the 238 patients had a brain MRI performed, and 5 patients had “MRIs strongly suggestive of demyelination” (MRSSD). Three patients were later diagnosed with multiple sclerosis and two were diagnosed with radiologically isolated syndrome. Adalimumab was not started in any of these patients. An additional 12 brain MRI scans showed nonspecific white matter lesions; in this cohort of patients, all underwent a neurology consultation and were safely started on adalimumab. The presence of bilateral idiopathic intermediate uveitis and/or neurologic symptoms were the most predictive factors for MRSSDs.

    Limitations

    Limitations of the study include its retrospective nature and the fact that the screening criteria for prompting the brain MRIs in this study population do not give an entirely accurate representation of the true prevalence of findings in patients with NIU.

    Clinical Significance

    These results show that neurologic symptoms and bilateral idiopathic intermediate uveitis were predictive of having an abnormal MRSSD in patients with NIU. Reports of rare but serious neurologic adverse events with the use of anti–tumor necrosis factor antagonists, including adalimumab, have been noted in patients with demyelination, though the reason behind these findings is not fully understood. While practice patterns vary by treating physician and institution, a brain MRI and a neurologic examination should be considered in at-risk patients before the initiation of adalimumab treatment.

    Financial Disclosures: Dr. Jessica Shantha discloses no financial relationships.