Abstract
To report the experience of our center with the use of adalimumab (ADA) for the treatment of severe refractory noninfectious paediatric uveitis. The study is a retrospective case series of all paediatric patients with refractory uveitis who were treated with ADA at the Paediatric Uveitis Unit of our center from 2008 to 2015. We present 12 patients (6 Juvenile idiopathic arthritis-associated uveitis, 4 idiopathic panuveitis, 1 early-onset sarcoidosis-associated panuveitis, and 1 intermediate uveitis), with uveitis in 19/24 eyes. Once ADA therapy was started, all the patients presented improved activity according to Standardization of Uveitis Nomenclature (SUN) criteria. Nine out of the 12 patients had structural damage before ADA could be started: cataract (n = 4), glaucoma (n = 2), cystic macular edema (n = 1), exudative retinal detachment (n = 1), and optic disk edema (n = 5). Visual acuity improved or maintained stable in 17/19 affected eyes, and only 2 eyes decreased its visual acuity because of structural damage, which was already present before ADA therapy. In our experience, ADA presents a good safety profile and is efficacious in the treatment of paediatric patients with different forms of refractory noninfectious uveitis.
References
Simonini G, Taddio A, Cattalini M, Caputo R, de Libero C, Parentin F, Pagnini I, Lepore L, Cimaz R (2013) Superior efficacy of adalimumab in treating childhood refractory chronic uveitis when used as first biologic modifier drug: adalimumab as starting anti-TNF-alpha therapy in childhood chronic uveitis. Pediatr Rheumatol Online J 11:16. doi:10.1186/1546-0096-11-16
Nagpal A, Leigh JF, Acharya NR (2008) Epidemiology of uveitis in children. Int Ophthalmol Clin 48(3):1–7. doi:10.1097/IIO.0b013e31817d740e
Heiligenhaus A, Foeldvari I, Edelsten C, Smith JR, Saurenmann RK, Bodaghi B, de Boer J, Graham E, Anton J, Kotaniemi K, Mackensen F, Minden K, Nielsen S, Rabinovich EC, Ramanan AV, Strand V (2012) Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis: a consensus effort from the multinational interdisciplinary working group for uveitis in childhood. Arthritis Care Res (Hoboken) 64(9):1365–1372. doi:10.1002/acr.21674
Cordero-Coma M, Sobrin L (2015) Anti-tumor necrosis factor-α therapy in uveitis. Surv Ophthalmol 60(6):575–589. doi:10.1016/j.survophthal.2015.06.004
Lerman MA, Burnham JM, Chang PY, Daniel E, Foster CS, Hennessy S, Jabs DA, Joffe MM, Kacmaz RO, Levy-Clarke GA, Mills MD, Nussenblatt RB, Rosenbaum JT, Suhler EB, Thorne JE, Kempen JH (2013) Response of pediatric uveitis to tumor necrosis factor-alpha inhibitors. J Rheumatol 40(8):1394–1403. doi:10.3899/jrheum.121180
Doycheva D, Zierhut M, Blumenstock G, Stuebiger N, Januschowski K, Voykov B, Deuter C (2014) Immunomodulatory therapy with tumour necrosis factor alpha inhibitors in children with antinuclear antibody-associated chronic anterior uveitis: long-term results. Br J Ophthalmol 98(4):523–528. doi:10.1136/bjophthalmol-2013-303935
Zannin ME, Birolo C, Gerloni VM, Miserocchi E, Pontikaki I, Paroli MP, Bracaglia C, Shardlow A, Parentin F, Cimaz R, Simonini G, Falcini F, Corona F, Viola S, De Marco R, Breda L, La Torre F, Vittadello F, Martini G, Zulian F (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(1):74–79. doi:10.3899/jrheum.120583
Simonini G, Taddio A, Cattalini M, Caputo R, De Libero C, Naviglio S, Bresci C, Lorusso M, Lepore L, Cimaz R (2011) Prevention of flare recurrences in childhood-refractory chronic uveitis: an open-label comparative study of adalimumab versus infliximab. Arthritis Care Res (Hoboken) 63(4):612–618. doi:10.1002/acr.20404
Bou R, Adan A, Borras F, Bravo B, Calvo I, De Inocencio J, Diaz J, Escudero J, Fonollosa A, de Vicuna CG, Hernandez V, Merino R, Peralta J, Rua MJ, Tejada P, Anton J (2015) Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus. Rheumatol Int 35(5):777–785. doi:10.1007/s00296-015-3231-3
Reiff A, Kadayifcilar S, Ozen S (2013) Rheumatic inflammatory eye diseases of childhood. Rheum Dis Clin North Am 39(4):801–832. doi:10.1016/j.rdc.2013.05.005
Marino A, Pagnini I, Giani T, Caputo R, Arapi I, Neri P, Cimaz R, Simonini G (2016) Successful treatment with adalimumab for severe multifocal choroiditis and panuveitis in presumed (early-onset) ocular sarcoidosis. Int Ophthalmol 36(1):129–135. doi:10.1007/s10792-015-0135-x
Neri P, Eandi C, Arapi I, Posarelli C, Mariotti C, Giovannini A (2013) Long-term control of non-infectious paediatric panuveitis refractory to traditional immunesuppressive therapy, successfully treated with Adalimumab (HumiraTM). Clin Exp Rheumatol 31(3):458–462
Imrie FR, Dick AD (2007) Biologics in the treatment of uveitis. Curr Opin Ophthalmol 18(6):481–486. doi:10.1097/ICU.0b013e3282f03d42
Schmeling H, Horneff G (2005) Etanercept and uveitis in patients with juvenile idiopathic arthritis. Rheumatology (Oxford) 44(8):1008–1011. doi:10.1093/rheumatology/keh658
Jabs DA, Nussenblatt RB, Rosenbaum JT (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 140(3):509–516
Angeles-Han ST, Griffin KW, Lehman TJ, Rutledge JR, Lyman S, Nguyen JT, Harrison MJ (2010) The importance of visual function in the quality of life of children with uveitis. J AAPOS 14(2):163–168. doi:10.1016/j.jaapos.2009.12.160
Lam LA, Lowder CY, Baerveldt G, Smith SD, Traboulsi EI (2003) Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated uveitis. Am J Ophthalmol 135(6):772–778
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors of this manuscript declare that they do not have any conflict of interest.
Rights and permissions
About this article
Cite this article
Muñoz-Gallego, A., Barral, E., Enríquez, E. et al. Adalimumab for the treatment of refractory noninfectious paediatric uveitis. Int Ophthalmol 37, 719–725 (2017). https://doi.org/10.1007/s10792-016-0293-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-016-0293-5