Predictive Factors for Magnetic Resonance Imaging Changes Suggestive of Demyelination in Adult Patients with Uveitis Scanned Prior to Commencing Adalimumab Therapy

ABSTRACT

Purpose

To report the predictive clinical factors for abnormal magnetic resonance imaging (MRI) scans suggestive of demyelination by analysis of MRI’s performed for adult non-infectious uveitic patients prior to commencing adalimumab therapy.

Methods

Retrospective case review of 240 patients was conducted in a single tertiary institution between November 2017 and March 2020. Aetiology of underlying disease, clinical characteristics, and MRI outcomes were analysed.

Results

The presence of bilateral idiopathic intermediate uveitis (IIU) (p = .0048) and neurological symptoms (p = .028) were highly predictive of an abnormal MRI strongly suggestive of demyelination (MRSSD); 5 out of 64 scans (7.8%) with these clinical characteristics had MRSSD.

Conclusions

Tumor necrosis factor antagonist-induced demyelination is a concern in adalimumab use. We propose an MRI screening protocol to identify those at high risk of demyelination; positive results can be maximised by screening all patients with IIU and those with neurological symptoms.

KEYWORDS:

• Adalimumab
• amgevita
• demyelination
• Humira
• Hyrimoz
• intermediate uveitis
• MRI
• MS
• multiple sclerosis
• screening
• TNF-α

Acknowledgments

Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All the data and images pertaining to this paper are available via the corresponding author.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.