Long-Term Effectiveness and Safety of Weekly Adalimumab in Refractory Non-Infectious Uveitis

Abstract

PurposeTo assess the efficacy and safety of weekly adalimumab after dose escalation in patients with chronic refractory non-infectious uveitis.MethodsA retrospective analysis was conducted on patients aged 18 years and older with persistent chronic uveitis despite bi-weekly adalimumab treatment. Data collected included uveitis diagnosis, anatomical site of involvement, history of immunosuppressive treatments, relapse frequency, and other relevant clinical parameters.ResultsThis study included 30 patients (18 females and 12 males) with a median age of 33.5 (22-57) years and a mean follow-up period of 62.6 +/- 25.2 months. Median visual acuity was 0.29 logMAR (0.22-0.40) with bi-weekly adalimumab treatment and improved to 0.20 logMAR (0.10-0.36) with weekly adalimumab treatment (p = 0.009). A significant reduction in central macular thickness was observed with weekly adalimumab treatment compared to the bi-weekly regimen (259.67 mu m vs. 336.47 mu m, p = 0.001). The frequency of relapses was 1.9 +/- 0.66 with bi-weekly treatment and 0.53 +/- 0.33 with weekly treatment (p = 0.001). The proportion of patients exhibiting active ocular inflammation requiring systemic steroids was 60% in the bi-weekly treatment, compared to 24.3% in the weekly treatment. In terms of adverse effect profile, both treatment modalities exhibited similar characteristics. Weekly adalimumab is associated with a significantly reduced risk of relapse compared with bi-weekly ADA (HR = 0.267, p = 0.001).ConclusionWeekly adalimumab treatment is a viable option for managing inflammation in refractory uveitis, providing enhanced efficacy to the standard dose in terms of visual and anatomical outcomes, while maintaining a comparable side effect profile.