Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK.
Division of Paediatric Rheumatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
Pediatr Rheumatol Online J. 2023 Mar 2;21(1):21. doi: 10.1186/s12969-023-00794-y.
Adalimumab in combination with other disease-modifying antirheumatic drugs (DMARD) such as methotrexate has a proven efficacy in the management of paediatric non-infectious uveitis. However, many children experience significant intolerance to methotrexate while on this combination, leaving a dilemma for clinicians for choosing the subsequent therapeutic roadmap. Continuation of adalimumab monotherapy might be an alternative feasible option under such settings. This study aims to investigate the efficacy of adalimumab monotherapy in paediatric non-infectious uveitis.
Children with non-infectious uveitis on adalimumab monotherapy (from August 2015 to June 2022) following intolerance to accompanying methotrexate or mycophenolate mofetil were included in this retrospective study. Data were collected at the initiation of adalimumab monotherapy and at three monthly intervals until the last visit. The primary outcome was to evaluate disease control on adalimumab monotherapy as determined by the proportion of patients who had less than a 2-step worsening in uveitis (as per SUN score) and no additional systemic immunosuppression during follow-up. Secondary outcome measures were visual outcome, complications and side-effect profile of adalimumab monotherapy.
Data was collected for 28 patients (56 eyes). The most common uveitis type and course were anterior and chronic uveitis respectively. Juvenile idiopathic arthritis-associated uveitis was the most common underlying diagnosis. During the study period, 23 (82.14%) of the study subjects met the primary outcome. On Kaplan-Meier survival analysis 81.25% (95% CI; 60.6-91.7%) children maintained remission at 12 months on adalimumab monotherapy.
Continuation of adalimumab monotherapy is an effective therapeutic option for the treatment of non-infectious uveitis in children who are intolerant to the combination of adalimumab and methotrexate or mycophenolate mofetil.
阿达木单抗联合甲氨蝶呤等其他疾病修饰抗风湿药物（DMARD）在儿童非感染性葡萄膜炎的治疗中已被证实具有疗效。然而，许多儿童在联合使用甲氨蝶呤时会出现明显的不耐受，这给临床医生在选择后续治疗方案时带来了困境。在这种情况下，继续使用阿达木单抗单药治疗可能是一种可行的替代选择。本研究旨在探讨阿达木单抗单药治疗儿童非感染性葡萄膜炎的疗效。
本回顾性研究纳入了 2015 年 8 月至 2022 年 6 月期间因不耐受甲氨蝶呤或吗替麦考酚酯而接受阿达木单抗单药治疗（从联合治疗转为单药治疗）的非感染性葡萄膜炎患儿。在开始阿达木单抗单药治疗时以及之后每 3 个月收集一次数据，直至最后一次就诊。主要结局是评估阿达木单抗单药治疗的疾病控制情况，即根据 SUN 评分，评估患者中葡萄膜炎恶化程度小于 2 步（即改善 2 个等级）且在随访期间未接受额外全身免疫抑制治疗的比例。次要结局指标包括阿达木单抗单药治疗的视力结果、并发症和副作用。
共收集了 28 例患者（56 只眼）的数据。最常见的葡萄膜炎类型和病程分别为前葡萄膜炎和慢性葡萄膜炎。幼年特发性关节炎相关性葡萄膜炎是最常见的基础诊断。在研究期间，23 例（82.14%）患者达到了主要结局。Kaplan-Meier 生存分析显示，81.25%（95%CI；60.6-91.7%）的儿童在阿达木单抗单药治疗 12 个月时维持缓解。
对于不耐受阿达木单抗联合甲氨蝶呤或吗替麦考酚酯的儿童非感染性葡萄膜炎患者，继续使用阿达木单抗单药治疗是一种有效的治疗选择。
