Lower Relapse Risk With Infliximab Than Adalimumab in Sight-Threatening Uveitis

Infliximab is associated with significantly lower risk of relapse compared with adalimumab in patients with sight-threatening noninfectious uveitis, according to a study published in the American Journal of Ophthalmology. Sight-threatening noninfectious uveitis was defined as those cases presenting with retinal vasculitis (RV) or cystoid macular edema (CME). The study shows that patients treated with adalimumab are twice as likely to experience a relapse of RV as those treated with infliximab. 

The findings also demonstrate that patients with a uveitis etiology of Behçet’s disease are more likely to respond to anti-TNF alpha agents, and relapse less frequently, than other causes of noninfectious uveitis.

To compare relapse rate of sight-threatening noninfectious uveitis in patients treated with either infliximab or adalimumab, the investigators conducted an observational, retrospective, multicenter study. They included all adult patients treated with infliximab or adalimumab for uveitis with either retinal vasculitis or macular edema, or both, between 2001 and 2019 in French tertiary centers. The primary outcome measure was relapse rate, and secondary outcome measures included complete response of noninfectious uveitis, corticosteroid-sparing effect, and safety.

Based on medical records, 330 patients (54.8% women and 45.2% men) with sight-threatening noninfectious uveitis treated with infliximab or adalimumab were included in the study. Patients had a median age of 36 years and uveitis etiology was idiopathic uveitis in 37.9%, Behçet’s disease in 27%, idiopathic juvenile arthritis in 5.8%, and sarcoidosis in 5.5%. The median follow-up duration was 74.50 months.

At 6 months after the introduction of the biological agents, the estimated relapse rate was 13% (95% confidence interval [CI], 0.009-0.16). Infliximab was associated with lower relapse risk than adalimumab (HR, 0.52; 95% CI, 0.36-0.77; P =.001). 

At 6 months, infliximab and adalimumab were comparable in terms of complete response rate of noninfectious uveitis (38.2% and 36.8%, respectively). Both treatments had a significant corticosteroid-sparing effect. For both infliximab and adalimumab, the median daily dose of prednisolone was 20 mg at the time of initiation and 10 mg at 6 months (P <.0004 and P <.0001, respectively). 

However, patients treated with infliximab more frequently experienced at least 1 side effect during treatment (24.% and 17.9%) and had more serious adverse events than those treated with adalimumab (14.7% and 9.5%, respectively).

Limitations of the study included the retrospective design and inability to collect complete longitudinal data on patients who were seen on an intermittent basis. 

Reference

Maalouf G, Andrillon A, Leclercq M, et al. Lower relapses rate with infliximab versus adalimumab in sight threatening uveitis: a multicenter study of 330 patients Am J Ophthalmol. Published online February 13, 2022. doi:10.1016/j.ajo.2022.02.002