Background Ocular involvement is a well known serious complication of Juvenile Idiopathic Arthritis (JIA), sometimes refractory to conventional treatment.
Objectives 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 another 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 s.c. every other week. The associated immunosuppressive therapy and the prednisone dose were reduced if there was no evidence of inflammation. The 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 comparisons were performed between baseline and 6 months after the onset of adalimumab therapy (Wilcoxon test).
Results Forty patients (11 males, 29 females), mean age of 11.4±7.9years (range: 4 to 44 years), with active intraocular inflammation at baseline were studied. Thirty-six of the 40 patients had inflammation in the anterior camera, and treatment with adalimumab achieved a significant improvement in the mean tyndall from 1.8±1.1 to 0.41±0.6; p=0.000001.
Also, 17 patients (42.5%) had inflammation in the posterior camera with foveal Optic Coherence Tomography (OCT) >250 microns. These cases had a significant improvement in OCT from 370.8±133.9 to 249.3±28 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). Following adalimumab, corticosteroid dose was decreased from 0.26±0.4 to 0.004±0.02mg/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.
Conclusions Adalimumab seems to be an effective and safe drug for the treatment of refractory JIA-associated uveitis. In addition, adalimumab may help to reduce corticosteroid requirement. Further controlled studies are warranted.
Disclosure of Interest None Declared
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