Response to Adalimumab in 40 Patients with refractory juvenile Idiopathic Arthritis-Associated Uveitis. A Multicenter Study

Vanesa Calvo-Río¹, Ricardo Blanco², Manuel Díaz-Llopis³, David Salom⁴, Carmen García-Vicuña⁵, Miguel Cordero-Coma⁶, Norberto Ortego⁷, Marta Suarez-de-Figueroa⁸, J. Carlos Fernandez-Cid⁹, A. Fonollosa Calduch¹⁰, Ángel M. García-Aparicio¹¹, Jose M. Benítez-del-Castillo¹², Jose L. Olea¹³, Javier Loricera¹⁴ and Miguel Angel González-Gay¹⁵, ¹Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain, ²Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Spain, Santander, Spain, ³Hospital Universitario La Fe de Valencia, Valencia, ⁴Department of Ophthalmology, Hospital Universitario La Fe de Valencia, Valencia, Spain, ⁵Hospital Sant Joan de Déu, Barcelona, Barcelona, ⁶Departament of Ophthalmology, Hospital de León, León, Spain, ⁷Hospital San Cecilio. Granada, Granada, Spain, ⁸Department of Ophthalmology, Hospital Ramon y Cajal, Madrid, Spain, ⁹Departament of Ophthalmology, Hospital de Pontevedra, Pontevedra, Spain, ¹⁰Ophthalmology, Hospital de Cruces, Barakaldo, Spain, ¹¹Hospital Virgen Salud, Toledo, Toledo, ¹²Departament of Ophthalmology, Hospital Clínico San Carlos, Madrid, ¹³Departament of Ophthalmology, Hospital Son Dureta, Palma de Mallorca, Spain, ¹⁴Rheumatology, Hospital Universitario Marqués de Valdecilla. IFIMAV. Santander. Spain, Santander, Spain, ¹⁵Rheumatology, Hospital Universitario Marqués de Valdecilla. IFIMAV, Santander, Spain

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Adalimumab, extraarticular manifestations and juvenile idiopathic arthritis (JIA)

Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Juvenile Idiopathic Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

To assess the efficacy and safety of treatment with adalimumab therapy in patients with refractory Juvenile Idiopathic Arthritis (JIA)-associated uveitis.

Methods:

Multicenter study on 40 patients diagnosed as having JIA-associated uveitis refractory to treatment with corticosteroids therapy and at least other systemic immunosuppressive drug. Standard adalimumab therapy was started (40 mg subcutaneously every-other-week); for children aged between 4 and 12 years, the recommended dose was 24 mg/m² body surface area up to a maximum single dose of 40 mg sc every other week. The associated immunosuppressive therapy and the prednisone dose were reduced if there was no evidence of inflammation. Degree of anterior and posterior chamber inflammation (SUN criteria), corticosteroid dose, and macular thickness (optical coherence tomography) were assessed. Definite outcomes were assessed at six months in all patients. All expressed comparisons are between baseline and after 6 months of adalimumab therapy (Wilcoxon test).

Results:

Forty patients (11 males, 29 females), mean age of 11,4±7,9 years (range: 4 to 44 years), with active intraocular inflammation at baseline were studied. Thirty-six of 40 patients had inflammation in the anterior camera, and treatment with adalimumab achieved a significant improvement in mean tyndall from 1,8±1,1 to 0,41±0,6 ; p =0.000001.

Also, 17 (42,5%) patients had macular thickness with Optic Coherence Tomography (OCT)>250 microns. These cases had a significant improvement in OCT from 370,8±133,9 to 249,3±28,0 microns; p=0,0007. In addition, 9 patients with Cystoid Macular Edema (CME) (OCT>300) also had a significant improvement in OCT (463,1±123,8 to 254,4±30,2, p=0,007). The dose of corticosteroids also was decreased from 0.26±0.4 to 0.004±0.02 mg/day (p=0.00061).

Adalimumab was usually well tolerated, and only local minor side-effects at the injection site were observed. Twelve patients (30%) had a mild relapse during the 6 months of therapy whereas only 2 patients (5%) had a moderate-severe relapse.

Conclusion: Adalimumab appears to be an effective and safe drug for the treatment of refractory JIA-associated uveitis and may reduce steroid requirement. Further controlled studies are warranted.

Disclosure:

V. Calvo-Río,
None;

R. Blanco,
None;

M. Díaz-Llopis,
None;

D. Salom,
None;

C. García-Vicuña,
None;

M. Cordero-Coma,
None;

N. Ortego,
None;

M. Suarez-de-Figueroa,
None;

J. C. Fernandez-Cid,
None;

A. Fonollosa Calduch,
None;

M. García-Aparicio,
None;

J. M. Benítez-del-Castillo,
None;

J. L. Olea,
None;

J. Loricera,
None;

M. A. González-Gay,
None.

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