Superior efficacy of Adalimumab in treating childhood refractory chronic uveitis when used as first biologic modifier drug: Adalimumab as starting anti-TNF-α therapy in childhood chronic uveitis

Abstract

BackgroundNonetheless biologic modifier therapies are available treatment strategies for sight-threatening uveitis in children, the lack of evidence from head-to-head randomized controlled studies limits our understanding of timing of therapy when to commence therapy, which agent to choose and how long to continue treatment, and, in case of failure, if switching to another anti-TNF-α strategy might be eventually an option. Our aim was to compare the efficacy of Adalimumab when used as first anti-TNFα therapy versus Adalimumab used after the failure of a previous anti-TNFα (Infliximab) in an open-label, comparative, multi-center, cohort study of childhood chronic uveitis.Methods26 patients (14 F, 12 M; median age: 8.6 years) with refractory, non-infectious active uveitis were enrolled. Due to the refractory course of uveitis to previous DMARD treatment, Group 1 received Adalimumab (24 mg/sq mt, every 2 weeks), as first anti-TNFα choice; Group 2 received Adalimumab, as second anti-TNFα drug, due to the loss of efficacy of Infliximab, administered after a period of at least 1 year. Both groups received Adalimumab for at least 1 year of treatment. Primary outcome was, once remission was achieved, the time to a first relapse.Results14 children (10 with JIA, 3 with idiopathic uveitis, 1 with Behçet’s disease) were recruited in Group 1; 12 children (7 with JIA, 3 with idiopathic uveitis, 1 with early-onset sarcoidosis, 1 with Behçet’s disease) in Group 2. Group 2 showed a lower probability to steroid discontinuation during the first 12 months of treatment (Mantel-Cox χ24.12, p<0.04). In long-term follow-up, Group 1 had higher probability of uveitis remission during the time of treatment on Adalimumab (median ±SE: 18 ±1.1 vs 4 ±0.6 months, CI 95%: 15.6-27.5 vs 2.7-5.2, Mantel-Cox χ210.12, p<0.002).ConclusionsEven if limited to a relatively small group, our study suggests a better efficacy of Adalimumab when used as first anti-TNFα treatment in childhood chronic uveitis.

Outcome of Juvenile Idiopathic Arthritis Associated Uveitis in Two Disease Subtypes

“…28,29,35 We should highlight that our patients were previously biologically naive, which might explain the high efficacy obtained. This is in accordance with the data of Simonini et al, 37 who also demonstrated better efficacy of adalimumab when used as a first anti-TNF-alpha treatment in chronic childhood uveitis. Steroid sparing effects, found in our patient cohort, enabled reduction and complete ending of steroids after commencing adalimumab and methotrexate, which is in concordance with published data.…”

Uveitis in Juvenile Idiopathic Arthritis: Recent Therapeutic Advances

“…There was a higher probability of remission over a 3-year period in the adalimumab-treated group. Zannin et al [11] estingly, adalimumab appears to be more effective in inducing remission when used as the primary biological therapy [12] . As highlighted by Mansour [13] , other advantages of adalimumab may be superior tolerability, lower immunogenicity and the option of home administration, being delivered by subcutaneous injection, in comparison with infliximab, which requires intravenous infusion.…”

The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation

“…All of them were observational in design (three case series; [106][107][108] one Italian registry-based study; 109 one comparative cohort study 110 ), and all assessed treatment with adalimumab (with one also assessing infliximab 110 in uveitis patient populations with varying proportions of JIA uveitis. We have not performed an independent critical appraisal of these studies in this assessment report.…”