Long-Term Effectiveness and Safety of Weekly Adalimumab in Refractory Non-Infectious Uveitis.

Purpose: To assess the efficacy and safety of weekly adalimumab after dose escalation in patients with chronic refractory non-infectious uveitis.

Methods: A retrospective analysis was conducted on patients aged 18 years and older with persistent chronic uveitis despite bi-weekly adalimumab treatment. Data collected included uveitis diagnosis, anatomical site of involvement, history of immunosuppressive treatments, relapse frequency, and other relevant clinical parameters.

Results: This study included 30 patients (18 females and 12 males) with a median age of 33.5 (22-57) years and a mean follow-up period of 62.6 ± 25.2 months. Median visual acuity was 0.29 logMAR (0.22-0.40) with bi-weekly adalimumab treatment and improved to 0.20 logMAR (0.10-0.36) with weekly adalimumab treatment (p = 0.009). A significant reduction in central macular thickness was observed with weekly adalimumab treatment compared to the bi-weekly regimen (259.67 µm vs. 336.47 µm, p = 0.001). The frequency of relapses was 1.9 ± 0.66 with bi-weekly treatment and 0.53 ± 0.33 with weekly treatment (p = 0.001). The proportion of patients exhibiting active ocular inflammation requiring systemic steroids was 60% in the bi-weekly treatment, compared to 24.3% in the weekly treatment. In terms of adverse effect profile, both treatment modalities exhibited similar characteristics. Weekly adalimumab is associated with a significantly reduced risk of relapse compared with bi-weekly ADA (HR = 0.267, p = 0.001).

Conclusion: Weekly adalimumab treatment is a viable option for managing inflammation in refractory uveitis, providing enhanced efficacy to the standard dose in terms of visual and anatomical outcomes, while maintaining a comparable side effect profile.