Adalimumab Treatments For Uveitis Improve Quality of Life, Work

A 12-month study shows that adalimumab treatment for noninfectious uveitis can improve patient quality of life and reduce uveitis-related medical visits, with data reported in the British Journal of Ophthalmology.

Previously, the open label trial VISUAL III (ClinicalTrials.gov: NCT03155243) indicated adalimumab can be a long-term therapeutic option for noninfectious intermediate, posterior, and panuveitis (NIIPPU). For this study, researchers aimed to establish a real-world effectiveness of adalimumab in patients with active NIIPPU.

The research team included a sample of 149 adults (mean age 42.3±15.2 years) treated at 24 sites in 12 countries from June 2017 to February 2020. Patients displayed active disease and had no prior adalimumab therapy. The primary objective was quiescence (defined as anterior chamber cells ≤0.5+ and vitreous haze grade ≤0.5+ bilaterally) with no new chorioretinal lesions.

Participants received adalimumab for an average of 216±93 days, and were examined every 3 months — 106 completed the full study. Quiescence was attained by 91% at one of the follow-up visits, and most individuals showed uveitis inactivity at each exam: 68% by 3 months, 77% at 6 months, 78% after 9 months, 77% by 1 year. Corticosteroid-free quiescence rose from 35% at 3 months to 52% by 1 year (P <.05).

Regarding continued drug response; by 6 months, 63% had no ocular flare at an exam with quiescence at the previous visits, and 76% after 1 year. Further, 17% of patients experienced a flare at 3 months, but this decreased to 10% after 12 months (P =.092). The improving numbers benefitted health care resource utilization (HRU) — in 6 months before baseline, 89% sought medical care for uveitis, compared with 21% during the last 3 months of follow-up. ER visits declined from 27% at study’s start to 0% by its conclusion.

VFQ-25 scores at baseline totaled 72.5 (IQR 55.8 to 89.1) points, increasing by 1 year to 88.2 (IQR 66.6 to 95.1) points. In the Work Productivity and Activity Impairment–Uveitis survey, participants reported improvements in all categories; such as performing activities, work productivity, and absenteeism. Concerning safety, in the full analysis set, 9% had a serious adverse event, but a majority were believed unrelated to adalimumab. Analyzed individually, 78% of adverse events resolved or were resolving, and 85% were mild to moderate.

Prior studies revealed less risk for recurring uveitis with adalimumab vs placebo, as well as reduced prednisone-equivalent dose requirement. “Despite progress in uveitis treatment, real-world scenarios show the continued use of long-term high-dose corticosteroids, highlighting the unmet needs in disease management,” according to the investigators. They estimated, based on US insurance claims data, that those with NIIPPU have 4.7-fold costlier prescription bills.

An observational design with no control group may limit this investigation, along with potential self-presentation bias of surveys and memory bias for reported HRU. Also, most participants were recruited from large urban areas. Strengths are the inclusion of patients with Behcet’s and Vogt-Koyanagi-Harada disease, and being the first real-world study to present data on quality of life and NIIPPU’s impact on health care resources.

Disclosures: AbbVie Inc. funded this study. Several study authors have disclosed affiliations with the biotech or pharmaceutical industries. Please see the original reference for a full list of disclosures.