Adalimumab in the treatment of pediatric patients with chronic noninfectious anterior uveitis

ABSTRACT

Introduction

Adalimumab is established as an effective treatment for pediatric noninfectious uveitis refractory to methotrexate. However current use of the medication is empiric, according to fixed-dosing regimens and a significant proportion of patients will be nonresponsive or suboptimally responsive to adalimumab.

Areas covered

There remains considerable scope to improve outcomes through tailoring treatment according to individual patient responsiveness. Monitoring of anti-drug antibodies and serum drug trough levels may assist in predicting which patients are likely to have a poor response to adalimumab and enable tailoring of regimens to individual patients.

Expert opinion

We propose use of these biomarkers to individualize therapy in suboptimally responding patients, and present an algorithm of treatment escalation for pediatric noninfectious uveitis.

KEYWORDS:

• Adalimumab
• noninfectious pediatric uveitis
• pediatric uveitis
• anti-drug antibodies
• uveitis treatment
• adalimumab monitoring

Article highlights

• Adalimumab is an effective treatment for pediatric noninfectious uveitis refractory to methotrexate.

• Evidence is poor for predicting which patients will be poorly responsive to adalimumab.

• Evidence is poor for determining ideal individualization of adalimumab treatment with respect to dose, frequency, and duration.

• Lower trough levels of adalimumab are associated with a worse clinical response.

• Anti-drug antibodies (ADA) are associated with increased drug clearance and lower trough levels.

• Increasing adalimumab from fortnightly to weekly dosing can improve trough levels and clinical response in ADA-negative patients.

• IADA-positive patients are less likely to respond to adalimumab dose increase.

Declaration of interest

A. Dick has undertaken consultancy for Abbvie and received a grant from Biogen. A. V. Ramanan has received consultancy, speaker fees/honoraria from Abbvie, Eli Lilly, Pfizer, Roche, Novartis, SOBI and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.