Evaluating the Effectiveness of Escalating to Weekly Adalimumab Dosing for the Treatment of Non-infectious Uveitis: A Multi-Center Study.

Purpose: To evaluate the effectiveness of adalimumab (ADA) dose escalation in patients with non-infectious uveitis who are inadequately controlled with standard dosing.

Design: Multi-center retrospective interventional case series.

Participants: Patients with non-infectious uveitis active on standard biweekly ADA dosing who had treatment escalated to weekly ADA dosing at 6 tertiary referral centers.

Methods: Demographic data and clinical findings were assessed at the time of ADA dose escalation and 6-months later. Mixed model analysis was performed to analyze clinical outcomes and to assess predictive factors of success.

Main outcome measures: Treatment success composite criteria included: (1) disease quiescence (≤0.5+ anterior chamber cell, ≤0.5+ vitreous haze, inactive retinal/choroidal lesions); (2) prednisone ≤7.5 mg/day; and (3) ≤2 drops/day of prednisolone or equivalent (4) no treatment discontinuation.

Results: Fifty patients (44.4±21.2 years old, n=35 female) from 6 tertiary referral centers were included. At 6 months following ADA escalation (median 184 days), 52% of patients had achieved treatment success. Specific inflammatory signs significantly reduced after ADA escalation included anterior chamber cell grade (p=0.025) and presence of active retinal/choroidal lesions (p=0.010). Prednisone was decreased from >7.5 mg daily to lower doses in 63% (p=0.015). The odds ratio for treatment success was 6.88 for patients with posterior uveitis (p=0.024) and 0.14 (p=0.005) for patients with panuveitis. The hazard ratio for treatment success was 3.73 (p=0.009) for eyes with active retinal vasculitis at the time of ADA escalation.

Conclusion: Escalation from standard biweekly ADA dosing to weekly ADA dosing achieved treatment success in over half of the patients. Posterior uveitis predicts a favorable chance of success, whereas panuveitis conveys a lower success rate.