Adalimumab demonstrated an acceptable side-effect profile in patients with noninfectious uveitis, according to findings published in the American Journal of Ophthalmology. Researchers say the treatment led to inactive disease or remission in a majority of cases after cessation of adalimumab without other systemic immunosuppressive medication.

Researchers conducted a retrospective clinical cohort study to evaluate the effectiveness of adalimumab and to assess the reasons for its discontinuation in a real-world setting.

The team conducted a medical chart review including all patients treated with adalimumab for noninfectious uveitis at 2 tertiary eye care centers in the Netherlands between May 2004, and September 2020. The primary outcome was the effectiveness of adalimumab (number of patients achieving inactive disease, remission and relapse-free survival). The secondary outcomes were the reasons for discontinuation, including side effects.


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A total of 633 eyes of 341 patients (median age, 44 years; interquartile range, 33-56; 61% women and 39% men) were treated with adalimumab. Most patients (86%) had bilateral eye involvement. The median follow-up duration was 4.9 years, with up to 14.7 years.

Overall, 87% of patients achieved inactive disease (72%) or remission (15%), and most (86%) patients had inactive disease at the end of follow up. The uveitis recurrence-free survival interval was 3.4 years (95% confidence interval, 2.7-4.2; range, 0-13). 

Of 341 patients, 193 (56.6%) discontinued adalimumab. Aside from remission, reasons for discontinuation were no response (n=10; 2.9%), relapse (n=27; 7.9%), or reasons unrelated to the effectiveness of treatment (n=99; 29.0%). 

Adverse events or complications and subjective side effects led to discontinuation in 43 (13%) and 22 (6.5%) patients, respectively. Adalimumab was deemed to have an acceptable side-effect profile. 

Adalimumab antibodies were present in 40 of 115 (35%) patients for which measurements were available. Adalimumab antibodies were correlated with lower adalimumab levels (P=.001) and were observed more often in patients on adalimumab monotherapy than those on additional therapies (78% vs 22%; P <.01)

“In this clinical cohort study consisting of uveitis patients treated with adalimumab, representing real-world data, it is demonstrated that the vast majority of patients treated with adalimumab have a good initial response and the majority of patients have a favorable long term outcome, i.e. inactive disease or remission,”  researchers report.

Limitations of the study included the retrospective design, lack of measurement of levels of serum adalimumab and adalimumab antibodies in all patients, and lack of inclusion of changes in topical therapy in the analysis.

Disclosure: This research was supported by AbbVie. Please see the original reference for a full list of disclosures.

Reference

Eurelings LEM, Missotten TOAR, van Velthoven MEJ, et al. Long-term follow-up of patients with uveitis treated with adalimumab: response rates and reasons for discontinuation of therapy. Am J Ophthalmol. Published online March 18, 2022. doi:10.1016/j.ajo.2022.03.017