Long-Term Efficacy and Safety of Adalimumab in Pediatric Non-Infectious Uveitis: Including Weekly Dosing Escalation in Refractory Cases

Purpose To evaluate the long-term efficacy and safety of adalimumab (ADA) in pediatric non-infectious uveitis (NIU), with particular emphasis on weekly dose escalation in refractory cases.Methods This retrospective cohort study included pediatric patients with NIU treated with ADA for ≥6 months between January 2016 and March 2023. A total of 48 patients (93 eyes) were analyzed. All patients initially received biweekly ADA in routine clinical practice, with escalation to weekly dosing in cases of persistent or relapsing inflammation. Outcomes included BCVA, intraocular inflammation grades, CMT, relapse frequency, and systemic corticosteroid use. A predefined subgroup analysis was performed in patients receiving weekly ADA (14 patients, 26 eyes). Cox proportional hazards regression was used to evaluate relapse risk.Results ADA therapy significantly improved BCVA and reduced intraocular inflammation, CMT, relapse frequency, and corticosteroid use (all p < 0.001). Patients requiring weekly escalation had higher baseline inflammatory activity and showed further clinical improvement with sustained inflammation control and fewer relapses. Weekly ADA escalation was independently associated with a lower relapse risk in Cox regression analysis (HR 0.103, 95% CI 0.034–0.312; p < 0.001). Treatment was well tolerated, with no increase in adverse events.Conclusion ADA is an effective and safe treatment for pediatric NIU. In patients with inadequate control on biweekly dosing, escalation to weekly ADA improves inflammation control and reduces relapse risk without compromising safety, and should be considered before switching biologic therapy.