Superior efficacy of Adalimumab in treating childhood refractory chronic uveitis when used as first biologic

Background

We previously reported that Adalimumab is more efficacious than Infliximab in maintaining remission of chronic childhood uveitis.

Aim

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). Open-label, comparative, multi-centre, cohort study of childhood non-infectious chronic uveitis.

Methods

26 patients (14 F, 12 M; median age: 8.6 years) with refractory, vision threatening, 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, after a period of at least 1 year (5 mg/kg at weeks 0, 2, 6 and then every 6–8 weeks). Both groups received Adalimumab for at least 1 year of treatment. Primary outcome was, once remission was achieved, the time to a first relapse. Time to achieve remission, and time to systemic corticosteroid discontinuation were also considered.

Results

14 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. Cox-regression analysis did not show statistical significant differences between the two groups with regard to time to achieve remission, whilst Group 2 needed a longer time to discontinuation steroid (median ±SE: 7 ±1.7 vs 3 ±0.9 months, CI 95%: 3.6-10.4 vs 1.1-4.8, p<0.001) and a lower probability to steroid discontinuation during the first 12 months of treatment (Mantel-Cox χ2 4.12, p<0.041). In long-term follow-up, Group 1 had higher probability of uveitis remission (time to first flare) than Group 2 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 χ2 10.1, p<0.002) (Figure 1).

Figure 1

Conclusions

Even if limited to a relatively small group, our study suggests a better efficacy of Adalimumab when used as first anti-TNFα treatment in chronic childhood uveitis.