title: Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients.
abstract: OBJECTIVE
  To evaluate adalimumab therapy in refractory uveitis.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  A total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated.
  
  
  METHODS
  Patients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6).
  
  
  METHODS
  Degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thickness (optical coherence tomography).
  
  
  RESULTS
  There were 61 men and 70 women (mean age, 27.3 years). The most common causes were juvenile idiopathic arthritis in 39 patients, pars planitis in 16 patients, and Behçet's disease in 13 patients. Twenty-seven patients had uveitis of idiopathic origin. Inflammation in the anterior chamber was present in 82% of patients and in the vitreous cavity in 59% of patients. Anterior chamber inflammation and vitreous inflammation decreased significantly (P < 0.001) from a mean of 1.51 and 1.03 at baseline to 0.25 and 0.14, respectively, at 6 months. Macular thickness was 296 (102) μ at baseline versus 240 (36) μ at the 6-month visit (P < 0.001). Visual acuity improved by -0.3 logMAR in 32 of 150 eyes (21.3%) and worsened by +0.3 logMAR (-15 letters) in 5 eyes (3.3%). The dose of corticosteroids also decreased from 0.74 (3.50) to 0.20 (0.57) mg/kg/day (P < 0.001). Cystoid macular edema, which was present in 40 eyes at baseline, showed complete resolution in 28 eyes at 6 months. The mean suppression load decreased significantly (8.81 [5.05] vs 5.40 [4.43]; P < 0.001). Six months after the initiation of the study, 111 patients (85%) were able to reduce at least 50% of their baseline immunosuppression load. Only 9 patients (6.9%) had severe relapses during the 6 months of follow-up.
  
  
  CONCLUSIONS
  Adalimumab seems to be well tolerated and helpful in decreasing inflammatory activity in refractory uveitis and may reduce steroid requirement. Further controlled studies of adalimumab for uveitis are warranted.
authors.affiliation: Service of Ophthalmology, Hospital Universitari i Politècnic La Fe, and Facultad de Medicina, Universidad de Valencia, Valencia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Díaz-Llopis
authors.forename: David
authors.initials: D
authors.lastname: Salom
authors.forename: Carmen
authors.initials: C
authors.lastname: Garcia-de-Vicuña
authors.forename: Miguel
authors.initials: M
authors.lastname: Cordero-Coma
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ortega
authors.forename: Norberto
authors.initials: N
authors.lastname: Ortego
authors.forename: Marta
authors.initials: M
authors.lastname: Suarez-de-Figueroa
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Rio-Pardo
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez-Cid
authors.forename: Alex
authors.initials: A
authors.lastname: Fonollosa
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.forename: Angel M
authors.initials: AM
authors.lastname: Garcia-Aparicio
authors.forename: Jose M
authors.initials: JM
authors.lastname: Benitez-Del-Castillo
authors.forename: Jose L
authors.initials: JL
authors.lastname: Olea
authors.forename: J Fernando
authors.initials: JF
authors.lastname: Arevalo
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage; D004351:Drug Resistance; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007279:Injections, Subcutaneous; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D056687:Off-Label Use; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014605:Uveitis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D016572:Cyclosporine; D000068879:Adalimumab; D008727:Methotrexate