Evaluating the Effectiveness of Escalating to Weekly Adalimumab Dosing for the Treatment of Noninfectious Uveitis: A Multicenter Study.

Abstract

To evaluate the effectiveness of adalimumab dosage escalation in patients with noninfectious uveitis that is controlled inadequately with standard dosing. Multicenter retrospective interventional case series. Patients with noninfectious uveitis receiving active standard biweekly adalimumab dosing who underwent treatment escalation to weekly adalimumab dosing at 6 tertiary referral centers. Demographic data and clinical findings were assessed at the time of adalimumab dosage escalation and 6 months later. Mixed-model analysis was performed to analyze clinical outcomes and to assess predictive factors of success. Treatment success composite criteria included: (1) disease quiescence (≤ 0.5+ anterior chamber cell, ≤ 0.5+ vitreous haze, inactive retinal or choroidal lesions), (2) prednisone 7.5 mg/day or less, and (3) 2 drops/day or less of prednisolone or equivalent (4) no treatment discontinuation. Fifty patients (mean ± standard deviation age, 44.4 ± 21.2 years; n = 35 female patients) from 6 tertiary referral centers were included. At 6 months after adalimumab escalation (median, 184 days), 52% of patients had achieved treatment success. Specific inflammatory signs significantly reduced after adalimumab escalation included anterior chamber cell grade (P = 0.025) and presence of active retinal or choroidal lesions (P = 0.010). Prednisone was decreased from more than 7.5 mg/day to lower dosages in 63% of patients (P = 0.015). The odds ratio for treatment success was 6.88 for patients with posterior uveitis (P = 0.024) and 0.14 (P = 0.005) for patients with panuveitis. The hazard ratio for treatment success was 3.73 (P = 0.009) for eyes with active retinal vasculitis at the time of adalimumab escalation. Escalation from standard biweekly adalimumab dosing to weekly adalimumab dosing achieved treatment success in more than half of the patients. Posterior uveitis predicts a favorable chance of success, whereas panuveitis conveys a lower success rate. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.