• Manuel Díaz-Llopis, David Salom, Carmen Garcia-de-Vicuña, Miguel Cordero-Coma, Gabriela Ortega, Norberto Ortego, Marta Suarez-de-Figueroa, Maria J Rio-Pardo, Carlos Fernandez-Cid, Alex Fonollosa, Ricardo Blanco, Angel M Garcia-Aparicio, Jose M Benitez-Del-Castillo, Jose L Olea, and J Fernando Arevalo.
• Service of Ophthalmology, Hospital Universitari i Politècnic La Fe, and Facultad de Medicina, Universidad de Valencia, Valencia, Spain.
• Ophthalmology. 2012 Aug 1; 119 (8): 1575-81.

ObjectiveTo evaluate adalimumab therapy in refractory uveitis.DesignProspective case series.ParticipantsA total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated.InterventionPatients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6).Main Outcome MeasuresDegree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thickness (optical coherence tomography).ResultsThere were 61 men and 70 women (mean age, 27.3 years). The most common causes were juvenile idiopathic arthritis in 39 patients, pars planitis in 16 patients, and Behçet's disease in 13 patients. Twenty-seven patients had uveitis of idiopathic origin. Inflammation in the anterior chamber was present in 82% of patients and in the vitreous cavity in 59% of patients. Anterior chamber inflammation and vitreous inflammation decreased significantly (P < 0.001) from a mean of 1.51 and 1.03 at baseline to 0.25 and 0.14, respectively, at 6 months. Macular thickness was 296 (102) μ at baseline versus 240 (36) μ at the 6-month visit (P < 0.001). Visual acuity improved by -0.3 logMAR in 32 of 150 eyes (21.3%) and worsened by +0.3 logMAR (-15 letters) in 5 eyes (3.3%). The dose of corticosteroids also decreased from 0.74 (3.50) to 0.20 (0.57) mg/kg/day (P < 0.001). Cystoid macular edema, which was present in 40 eyes at baseline, showed complete resolution in 28 eyes at 6 months. The mean suppression load decreased significantly (8.81 [5.05] vs 5.40 [4.43]; P < 0.001). Six months after the initiation of the study, 111 patients (85%) were able to reduce at least 50% of their baseline immunosuppression load. Only 9 patients (6.9%) had severe relapses during the 6 months of follow-up.ConclusionsAdalimumab seems to be well tolerated and helpful in decreasing inflammatory activity in refractory uveitis and may reduce steroid requirement. Further controlled studies of adalimumab for uveitis are warranted.Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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