The Effect of Adalimumab on Refractory Uveitis

Purpose: To assess the efficacy and safety of Adalimumab (Humira , AbbVie, Chicago, IL, USA) for repeated refractory uveitis during systemic steroid or immunosuppressive therapy. Methods: We retrospectively reviewed clinical records on 30 eyes of 18 patients with non-infectious refractory uveitis who underwent Adalimumab injection therapy from December 2017 to July 2019. The therapeutic effect was assessed based on intraocular inflammation grade, central macular thickness, and best corrected visual acuity, and the efficacy was assessed based on control of inflammation and macular edema, as well as corticosteroid sparing effects. The safety was assessed based on adverse events. Results: The mean duration of uveitis at baseline was 55.4 months (13-121 months) and the mean follow-up was 9.2 months (6-18 months). All 30 eyes of 18 patients stopped using systemic steroids and maintained clinical quiescence. Anterior chamber inflammation, vitreous inflammation, and best corrected visual acuity showed significant improvement, and there was no difference in central macular thickness. Uveitis recurred in 5 eyes, but 4 eyes showed controlled inflammation after single posterior sub-tenon steroid injection. One eye was controlled after methotrexate co-administration. Ulticaria (two patients) and injection-site reaction (one patient) were reported as adverse events. Conclusions: Adalimumab is an effective treatment for decreasing inflammatory activity and reducing corticosteroid burden in refractory uveitis.