Efficacy of Adalimumab in pediatric non-infectious uveitis with apparent and non-apparent anterior uveitis

Abstract

Background Adalimumab (ADA) has been used for treating various types of pediatric non-infectious uveitis. Existing studies lack an examination of the correlation between the clinical characteristics of uveitis and the success rate of ADA treatment. The present study is to identify the clinical characteristic of cases that is related to the response rate of ADA treatment. Methods A retrospective review of medical records was conducted for pediatric patients with non-infectious uveitis undergoing ADA treatment for a minimum of six months. The patients were stratified into two groups: apparent anterior uveitis (AAU) and with non-apparent anterior uveitis (NAAU). Outcomes including best-corrected visual acuity (BCVA), anterior chamber cell (ACC), vitreous haze (VH) grade, retinal nerve fiber layer (RNFL) thickness, fundus fluorescein angiography (FA) scores, as well as systemic immunosuppression therapy (IMT) and glucocorticoid load, were assessed. Treatment success was defined based on a composite outcome involving the aforementioned variables. Results The study included 59 patients (111 eyes), with 44 patients (83 eyes, 74.58%) falling into the AAU group and 15 patients (28 eyes, 25.42%) in the NAAU group. Following 6-month of ADA treatment in the AAU group, there was a significant improvement in BCVA (p < 0.001), improved ACC (p < 0.001) and VH (p < 0.001), decreased RNFL thickness (p < 0.001), reduced FA scores (p < 0.001). Conversely, no significant differences were observed in BCVA, VH, RNFL thickness, FA scores between baseline and the 6-month follow-up visit in the NAAU group. There was also a significant decrease in systemic IMT and glucocorticoid dosing, comparing baseline to the 6-month follow-up visit in both the AAU (p < 0.001) and NAAU groups (p < 0.05). The rate of treatment success in the AAU group was significantly higher compared to that in NAAU patients (93.18% vs. 20%, p < 0.001). Conclusion ADA demonstrates superior efficacy in the treatment of pediatric non-infectious uveitis with AAU compared to NAAU.