Background/Purpose:

Treatment of juvenile idiopathic arthritis (JIA)–associated uveitis  is one of the serious problems of paediatric rheumatology. JIA associated uveitis often is refractory to MTX, CiA and topical NSAIDs and GC. Humanised anti-TNFα monoclonal antibody (adalimumab) may be effective drug for the treatment of JIA-associated uveitis refractory to immunosuppressive drugs. Objectives: To evaluate clinical efficacy and safety of adalimumab therapy in patients with JIA-associated uveitis.

Methods: It was prospective, observational trial. 48 patients with uveitis were enrolled in the study, 8 boys and 40 girls, 32–with bilateral and 16-with unilateral uveitis, 27 had poly-, 21-oligoarthritis. Mean age of patients was 11,8 (range 4–18) y; mean of disease duration–5,7 (range 1–16) y. Before adalimumab therapy 10 patients were treated with MTX (range of dose 15-25 mg/m²/w), 38–with MTX in combination with CiA (range of dose 4-4,5 mg/kg/d), 5 – with oral GC (range of dose 5-12 mg/kg/d), all of them–with topical GC drops, NSAID drops, 27 –received retrobulbar injections of GC. Adalimumab was administrated by subcutaneous injection at dose 40 mg every 2 w during 1y. Adalimumab use was approved by the Local Ethics Committee. The efficacy of therapy was measured by ACR-pedi criteria. Changes in ocular inflammation were graded by M.J.Hogan’s criteria. The main target – remission of uveitis and arthritis.

Results: Prior to administration of adalimumab, injection of conjunctiva, edema of iris, corneal precipitations, areas of inflammation in lens and optical nerve disk edema were found in all children with uveitis. After 8 w of treatment complete management of conjunctiva injection, iris edema and optical nerve disk edema were reported in 55%(44/80) of the affected eyes –  corneal precipitations disappeared in 45%(36/80); inflammation-associated changes of lens – in 18%(14/80) of eyes. Treatment-associated improvement of vision was found in 63 of 80 of the affected eyes; no changes of vision acuity were reported in 33(41%) of the affected eyes. GC eye drops were discontinued in 45%(22/48) of patients, NSAIDs eye drops – in 50%(24/48) of children; the dose of GC eye drops was reduced in 86%(41/48) of patients. The exacerbation of uveitis was persisting in 10%(8/80) of the affected eyes, subacute uveitis – in 25%(20/80); remission was found in 65%(52/80) of the affected eyes. After 24 w of treatment the cases of uveitis were not reported; subacute disease was observed in 22%(21/96) of eyes; remission was diagnosed in 78%(62/80) of the affected eyes. After 52 w of treatment remission was diagnosed in 83% of the affected eyes (66/80) The ACR-Pedi 30, 50, 70 were achieved 100%, 80%, 60% of patients at w 4, respectively. After 24 w of therapy ACR-Pedi 30,50,70 and 90 improvements rates was registrated in 100 %,92 %,78 % of patients. The remission was achieved by 63% of patient at w 52. Serious adverse events were not found.

Conclusion: Adalimumab is effective in patients with JIA associated uveitis. Reduction in uveitis activity and remission were reported in 83% of affected eyes. Remission of disease – in 63% of patients.The high efficacy of adalimumab allowed avoiding oral prednisolone and discontinuing topical GC therapy in patients with uveitis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adalimumab-effective-control-under-refractory-jia-associated-uveitis/