Advertisement

Clinical Rheumatology

, Volume 37, Issue 2, pp 549–553 | Cite as

Safety of weekly adalimumab in the treatment of juvenile idiopathic arthritis and pediatric chronic uveitis

  • Colleen K. CorrellEmail author
  • Danielle R. Bullock
  • Rachel M. Cafferty
  • Richard K. Vehe
Brief Report

Abstract

Weekly adalimumab dosing is used to treat juvenile idiopathic arthritis (JIA), uveitis, and other pediatric rheumatic diseases, but the safety of such dosing has not previously been studied. A retrospective chart review was conducted to assess the safety of weekly adalimumab. Demographic and clinical data were collected. Basic descriptive analysis was performed to assess for adverse events from weekly adalimumab. Sixty-nine patients at the University of Minnesota or Gillette Children’s Hospital were identified as treated with weekly adalimumab. Sixty (87%) were eligible for the chart review. Weekly adalimumab was used most commonly to treat uveitis (28%, 17/60) and rheumatoid factor-negative polyarticular JIA (25%, 15/60). Mean age at the start of weekly dosing was 13.9 years. The majority of patients were concurrently treated with a non-steroidal anti-inflammatory drug and methotrexate. Fifty-three (90%) patients continued weekly dosing for greater than 3 months. The mean duration of weekly adalimumab was 2 years. Throughout the duration of weekly dosing, 24/60 (40%) patients had documented minor infections not requiring antimicrobials and 24/60 (40%) had documented infections requiring antimicrobial treatment. Only three patients (5%) had an infection requiring hospitalization. Two patients (3%) developed autoimmune disease. Laboratory abnormalities and injection site reactions were rare. Weekly adalimumab was used most commonly to treat uveitis and rheumatoid factor-negative polyarticular JIA, and mean duration of weekly dosing was 2 years. Serious adverse events were rare.

Keywords

Adalimumab Juvenile idiopathic arthritis Pediatric rheumatology Uveitis 

Notes

Acknowledgements

The authors would like to thank Betty Bishop, Registered Nurse, for proposing this research idea.

Compliance with ethical standards

All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This study was approved by the University of Minnesota Institutional Review Board (IRB Code Number: 1511M80622).

Disclosures

None.

References

  1. 1.
    Humira Package Insert (2016). http://www.rxabbvie.com/pdf/humira.pdf
  2. 2.
    Lovell DJ, Ruperto N, Goodman S et al (2008) Adalimumab with or without methotrexate in juvenile rheumatoid arthritis. N Engl J Med 359:810–820.  https://doi.org/10.1056/NEJMoa0706290 CrossRefPubMedGoogle Scholar
  3. 3.
    Beukelman T, Ringold S, Davis TE et al (2012) Disease-modifying antirheumatic drug use in the treatment of juvenile idiopathic arthritis: a cross-sectional analysis of the CARRA Registry. J Rheumatol 39:1867–1874.  https://doi.org/10.3899/jrheum.120110 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Burgos-Vargas R, Tse SM, Horneff G et al (2015) A randomized, double-blind, placebo-controlled multicenter study of adalimumab in pediatric patients with enthesitis-related arthritis. Arthritis Care Res (Hoboken) 67:1503–1512.  https://doi.org/10.1002/acr.22657 CrossRefGoogle Scholar
  5. 5.
    Zannin ME, Birolo C, Gerloni VM et al (2013) Safety and efficacy of infliximab and adalimumab for refractory uveitis in juvenile idiopathic arthritis: 1-year followup data from the Italian Registry. J Rheumatol 40:74–79.  https://doi.org/10.3899/jrheum.120583 CrossRefPubMedGoogle Scholar
  6. 6.
    van de Putte LB, Atkins C, Malaise M et al (2004) Efficacy and safety of adalimumab as monotherapy in patients with rheumatoid arthritis for whom previous disease modifying antirheumatic drug treatment has failed. Ann Rheum Dis 63:508–516.  https://doi.org/10.1136/ard.2003.013052 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sandborn WJ, Hanauer SB, Rutgeerts P et al (2007) Adalimumab for maintenance treatment of Crohn’s disease: results of the CLASSIC II trial. Gut 56:1232–1239CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kimball AB, Kerdel F, Adams D et al (2012) Adalimumab for the treatment of moderate to severe hidradenitis suppurativa: a parallel randomized trial. Ann Intern Med 157:846–855.  https://doi.org/10.7326/0003-4819-157-12-201212180-00004 CrossRefPubMedGoogle Scholar
  9. 9.
    Leonardi C, Sobell JM, Crowley JJ et al (2012) Efficacy, safety and medication cost implications of adalimumab 40 mg weekly dosing in patients with psoriasis with suboptimal response to 40 mg every other week dosing: results from an open-label study. Br J Dermatol 167:658–667.  https://doi.org/10.1111/j.1365-2133.2012.11041.x CrossRefPubMedGoogle Scholar
  10. 10.
    Wolf D, D’Haens G, Sandborn WJ et al (2014) Escalation to weekly dosing recaptures response in adalimumab-treated patients with moderately to severely active ulcerative colitis. Aliment Pharmacol Ther 40:486–497.  https://doi.org/10.1111/apt.12863 PubMedGoogle Scholar
  11. 11.
    Dubinsky MC, Rosh J, Faubion WA Jr et al (2016) Efficacy and safety of escalation of adalimumab therapy to weekly dosing in pediatric patients with Crohn’s disease. Inflamm Bowel Dis 22:886–893.  https://doi.org/10.1097/MIB.0000000000000715 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Aljebab F, Choonara I, Conroy S (2017) Systematic review of the toxicity of long-course oral corticosteroids in children. PLoS One 12:e0170259.  https://doi.org/10.1371/journal.pone.0170259 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ghiti Moghadam M, Vonkeman HE, ten Klooster PM et al (2016) Stopping tumor necrosis factor inhibitor treatment in patients with established rheumatoid arthritis in remission or with stable low disease activity: a pragmatic multicenter, open-label randomized controlled trial. Arthritis Rheumatol 68:1810–1817.  https://doi.org/10.1002/art.39626 CrossRefPubMedGoogle Scholar
  14. 14.
    A LOOK AT TARGETED IMMUNE MODULATORS. WWW.ICER-REVIEW.ORG 1. Accessed 9/26/2017
  15. 15.
    Ungar WJ, Costa V, Hancock-Howard R et al (2011) Cost-effectiveness of biologics in polyarticular-course juvenile idiopathic arthritis patients unresponsive to disease-modifying antirheumatic drugs. Arthritis Care Res (Hoboken) 63:111–119.  https://doi.org/10.1002/acr.20337 CrossRefGoogle Scholar
  16. 16.
    Ramos-Casals M, Brito-Zerón P, Soto MJ et al (2008) Autoimmune diseases induced by TNF-targeted therapies. Best Pract Res Clin Rheumatol 22:847–861.  https://doi.org/10.1016/j.berh.2008.09.008 CrossRefPubMedGoogle Scholar
  17. 17.
    Zhu TH, Nakamura M, Abrouk M et al (2016) Demyelinating disorders secondary to TNF-inhibitor therapy for the treatment of psoriasis: a review. J Dermatolog Treat 27:406–413.  https://doi.org/10.3109/09546634.2015.1136385 CrossRefPubMedGoogle Scholar
  18. 18.
    Mannion ML, Beukelman T (2013) What is the background incidence of malignancy in children with rheumatic disease? Curr Rheumatol Rep 15:310–312.  https://doi.org/10.1007/s11926-012-0310-2 CrossRefPubMedGoogle Scholar
  19. 19.
    Nash P, Vanhoof J, Hall S et al (2016) Randomized crossover comparison of injection site pain with 40 mg/0.4 or 0.8 mL formulations of adalimumab in patients with rheumatoid arthritis. Rheumatol Ther 3:257–270.  https://doi.org/10.1007/s40744-016-0041-3 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Observational study of pediatric rheumatic diseases: the CARRA Registry. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02418442?term=carra+registry&rank=2. Accessed 1 Feb 2017

Copyright information

© International League of Associations for Rheumatology (ILAR) 2017

Authors and Affiliations

  • Colleen K. Correll
    • 1
    Email author
  • Danielle R. Bullock
    • 1
  • Rachel M. Cafferty
    • 2
  • Richard K. Vehe
    • 1
  1. 1.Division of Rheumatology, Department of PediatricsUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of PediatricsUniversity of MinnesotaMinneapolisUSA

Personalised recommendations