Background/Purpose: Childhood Chronic Idiopathic Uveitis (cCIU) is a severe ocular condition that accounts for the 40% of all uveitis in children. Its timely and proper treatment is critical to prevent severe complications. Our purpose isto report the treatment response of a large cohort of cCIU.

Methods: This is a retrospective multicentre international observation study conducted at Meyer Children’s Hospital IRCCS and Bristol Royal Hospital for children. The medical records of children were reviewed if they have a diagnosis of cCIU prior to 16 years old, and received a systemic treatment other than corticosteroids. We collected demographic, clinical and laboratory data. The main outcome was the achievement of response and remission on treatment according to SUN criteria.

Results: 146 cCIU (76 male, 42 ANA positive) with a median age at onset of 112months (range 20-199), 122 had a bilateral involvement (83.6%), 78 had anterior uveitis (53.4%), 17 anterior+intermediate (11.6%), 32 intermediate (21.9%) and 19 panuveitis (13%) were screened for inclusion criteria (see table 1). 115 patients received at least one systemic therapy other than corticosteroids (78.8%), 68 two different lines (46.6%), 20 three-line treatment (13.7%), and 3 four-line treatment (2.1). The median time for the first drug administered was 6 months (range 0-73). As first line-treatment 93 children received methotrexate (63.7%), 21 adalimumab (14.4%) (of whom 4 with concomitant methotrexate), and 1 mycophenolate mofetil (MMF) (0.7%). As second line treatment 6 received methotrexate, 45 adalimumab, 15 MMF, 1 azathioprine, and 1 tacrolimus. Among the first-line therapies, we observed that patients treated with adalimumab achieved more frequently ocular response (19/21 vs 55/91 χ² 8.72 p 0.01) and ocular remission (19/21 vs 42/45 χ² 12.2 p < 0.001), with no difference in frequency of relapse on therapy and time to first relapse on the therapy (see table 2). Additionally, cCIU with worse visual acuity ( >0.4 LogMAR) were less likely to achieve disease remission with methotrexate as first-line treatment (χ² 6.7p 0.035). Among the second-line therapy, adalimumab achieved more frequently ocular remission (38/1 (ADA) vs 5/1 (MTX) vs 9/12 (MMF), χ² 6.29 p 0.043) (table 2).

Conclusion: Adalimumab showed better chance to achieve ocular remission, as first and second line treatment, as well as in patients with worst outcome: ANA positivity, worse visual acuity, intermediate uveitis. Acknowledgements: All the patients that received adalimumab as first line treatment were followed at Meyer Children’s Hospital IRCCS, and the off label prescription authorization was obtained.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/superiority-of-adalimumab-in-treating-childhood-chronic-idiopathic-uveitis-evidence-from-a-multicentre-experience/