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Weekly Adalimumab, an Effective Alternative for Refractory Uveitis in Children

BACKGROUND Chronic uveitis in children, if inadequately treated, can cause cataracts, glaucoma, and ultimately vision loss. Topical steroids used to control inflammation can also cause complications including cataracts and glaucoma. Adalimumab, a subcutaneous human monoclonal antibody to tumor necrosis factor α (TNF-α), has been shown to effectively reduce uveitis flares in adult cohorts and to reduce uveitis flares and topical steroid requirement in uveitis associated with juvenile idiopathic arthritis (JIA). Although adalimumab has been studied and approved for use at every 2 weeks (Q2week) dosing only, many rheumatologists increase the frequency to weekly (Q1 week) dosing if uveitis remains uncontrolled on a Q2 week regimen. The Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plan for uveitis also includes adalimumab Q1 week as a treatment option. However, the efficacy of Q1 week dosing of adalimumab in children has not been evaluated formally. We conducted a single-center review to assess the effectiveness of adalimumab Q1 week in treating uveitis refractory to adalimumab Q2 weeks, compared with patients switched to infliximab, a chimeric monoclonal anti–TNF-α antibody administered intravenously, as reference.