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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Treatment of refractory uveitis with adalimumab: A prospective multicenter study of 131 patients
Ophthalmology, Volume 119, No. 8, Year 2012
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Description
Objective: To evaluate adalimumab therapy in refractory uveitis. Design: Prospective case series. Participants: 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. Intervention: 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). Main Outcome Measures: 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. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.
Authors & Co-Authors
Díaz-Llópis, Manuel J.
Spain, Valencia
Hospital Universitari I Politècnic la fe
Spain, Madrid
Hospital Clínico San Carlos
Salom, David
Spain, Valencia
Hospital Universitari I Politècnic la fe
García-De-Vicuña, Carmen
Spain, Esplugues de Llobregat
Hospital Sant Joan de Déu Barcelona
Cordero-Coma, Miguel
Spain, Leon
Hospital de León
Ortega-Larrocea, Gabriela
Mexico, Mexico
Instituto Nacional de Rehabilitación
Ortego-Centeno, Norberto
Spain, Granada
Hospital Universitario San Cecilio
Figueroa, Marta S.
Spain, Madrid
Hospital Universitario Ramón y Cajal
Rio-Pardo, Maria J.
Spain, Malaga
Hospital Regional Universitario Carlos Haya
Fernández-Cid, Carlos Marras
Spain, Pontevedra
Hospital de Pontevedra
Fonollosa, Alex
Spain, Baracaldo
Osakidetza, Cruces University Hospital
Blanco-Alonso, Ricardo
Spain, Santander
Hospital Universitario Marqués de Valdecilla
García-Aparicio, Ángel María
Spain, Toledo
Complejo Hospitalario de Toledo
Benítez-Del-Castillo-Sánchez, José M.
Spain, Madrid
Hospital Clínico San Carlos
Olea, José Luis
Spain, Palma
Hospital Universitario Son Espases
Arévalo, José Fernando
Venezuela, Caracas
Clinica Oftalmologica Centro Caracas
United States, Baltimore
Wilmer Eye Institute
Saudi Arabia, Riyadh
King Khaled Eye Specialist Hospital
Statistics
Citations: 216
Authors: 15
Affiliations: 16
Identifiers
Doi:
10.1016/j.ophtha.2012.02.018
e-ISSN:
15494713
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Cohort Study
Participants Gender
Male
Female