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.

Nonetheless biologic modifier therapies are available treatment strategies for sight-threatening uveitis in children, the lack of evidence from head-to-head randomized controlled studies limits our understanding of timing of therapy when to commence therapy, which agent to choose and how long to continue treatment, and, in case of failure, if switching to another anti-TNF-alpha strategy might be eventually an option. Our aim was to compare the efficacy of Adalimumab when used as first anti-TNFalpha therapy versus Adalimumab used after the failure of a previous anti-TNFalpha (Infliximab) in an open-label, comparative, multi-center, cohort study of childhood chronic uveitis. METHODS:26 patients (14 F, 12 M; median age: 8.6 years) with refractory, non-infectious active uveitis were enrolled. Due to the refractory course of uveitis to previous DMARD treatment, Group 1 received Adalimumab (24 mg/sq mt, every 2 weeks), as first anti-TNFalpha choice; Group 2 received Adalimumab, as second anti-TNFalpha drug, due to the loss of efficacy of Infliximab, administered after a period of at least 1 year. Both groups received Adalimumab for at least 1 year of treatment. Primary outcome was, once remission was achieved, the time to a first relapse. RESULTS:14 children (10 with JIA, 3 with idiopathic uveitis, 1 with Behcet's disease) were recruited in Group 1; 12 children (7 with JIA, 3 with idiopathic uveitis, 1 with early-onset sarcoidosis, 1 with Behcet's disease) in Group 2. Group 2 showed a lower probability to steroid discontinuation during the first 12 months of treatment (Mantel-Cox chi24.12, p<0.04). In long-term follow-up, Group 1 had higher probability of uveitis remission during the time of treatment on Adalimumab (median +/-SE: 18 +/-1.1 vs 4 +/-0.6 months, CI 95%: 15.6-27.5 vs 2.7-5.2, Mantel-Cox chi210.12, p<0.002). CONCLUSIONS: Even if limited to a relatively small group, our study suggests a better efficacy of Adalimumab when used as first anti-TNFalpha treatment in childhood chronic uveitis.