Adalimumab in Focus: Evaluating Effectiveness and Safety in Non-Infectious Uveitis at a Tertiary Referral Center in Türkiye

Abstract

Objectives: To evaluate the indications, efficacy, and safety of adalimumab (ADA) in treating active non-infectious uveitis (NIU) in the Turkish population in a real-world setting.

Materials and methods: This retrospective observational study included patients diagnosed with NIU treated with ADA on-label. The study assessed the impact of ADA treatment on best corrected visual acuity (BCVA), number of immunosuppressive therapies (IST), immunosuppressive drug load, and the frequency of required local treatment. BCVA was monitored at baseline and subsequent months to determine the onset of functional efficiency of ADA treatment.

Results: A total of 289 eyes of 146 patients (60 females, 86 males) diagnosed with NIU and treated according to the ADA protocol were included in the study. The mean age was 37.6±14.4 years (range, 4-73) and the median follow-up was 30 months (interquartile range, 18-57). The most common indication for ADA was panuveitis, with a diagnosis of Behçet's uveitis. The use of ADA reduced the number of IST, immunosuppressive drug load, and need for local treatment (p<0.001, 0.002, and <0.001, respectively). Corticosteroids could be discontinued in all but one patient. Following ADA, a significant improvement in BCVA was observed from the first month (p<0.001 for baseline vs. month 1) and stabilization occurred after the sixth month (p=0.751 for month 6 vs. 12). Side effects were reported by 55.2% of patients during IST, while only 8 patients (5.5%) experienced ADA-related side effects. At the end of the follow-up period, 8.9% of patients switched to a weekly dosing schedule. Patients who switched to a weekly regimen required more local treatment before and after ADA treatment (p=0.02 and 0.001, respectively), and the number of concomitant IST and drug load were higher during standard-dose ADA use (p<0.001 and p=0.025, respectively).

Conclusion: This study, the largest single-center investigation in Türkiye, reveals ADA to be a safe option with functional benefits across diverse indications and age ranges. Notably, ADA minimizes reliance on additional therapies.

Keywords: Adalimumab; Behçet uveitis; TNF-α antagonist; immunosuppressive drug load; non-infectious uveitis.

Figure 1

Adalimumab (ADA) use status of patients *Remission was diagnosed in three patients with Behçet’s uveitis, one with sarcoidosis and one with Vogt-Koyanagi-Harada (VKH) disease **ADA treatment was discontinued in 2 patients with serpiginous choroiditis due to skin rash, 1 patient with serpiginous choroiditis due to pulmonary tuberculosis and 1 patient with VKH due to lymph adenopathy. The symptoms of dermatological conditions that manifested during ADA administration abated with the cessation of ADA and did not recur upon the resumption of ADA

Figure 2

Changes in the mean best corrected visual acuity (BCVA). Patients diagnosed with spondyloarthropathy-associated uveitis were excluded (Wilcoxon signed-rank test) logMAR: Logarithm of the minimum angle of resolution