Uveitis is a condition in which inflammation occurs deep inside the eye. In children, the condition is more likely to lead to blindness than in adults. For this reason, finding the right treatment for children is critical.
A recent study found that Humira (adalimumab) was effective in treating children with refractory uveitis — a type of uveitis for which standard treatments no longer work. However, the medication seemed to become less effective over time.
This study was led by Luciano Bravo-Ljubetic, MD, of the Ophthalmology Service of the Instituto de Investigacion Hospital Universitario La Paz in Spain. The research team examined whether adalimumab therapy was effective in treating pediatric refractory uveitis.
Uveitis is inflammation that occurs in the middle layer of the eye (uvea) that carries blood supply to other parts of the eye. Pediatric refractory uveitis is a type of uveitis that occurs in children and which no longer effectively responds to treatment.
For this study, the researchers analyzed data on 15 children between 5 and 17 years old. All of the study participants had uveitis that did not respond to standard treatment.
Participants in the study sample either had idiopathic or juvenile idiopathic arthritis-associated refractory non-infectious uveitis and were attending pediatric rheumatic and ophthalmology clinics at the University Hospital of La Paz between 2007 and 2012. Juvenile idiopathic arthritis (JIA) occurs in children under the age of 16 and involves swelling in one or more joints that lasts at least six weeks.
At each clinical visit, all participants had an eye exam given by one of two eye doctors. Each participant saw the same eye doctor at each visit, and eye exams were initially scheduled for at least once every month.
The eye doctors looked at inflammation to determine the success of treatment and graded it from 0 to 4. Inflammation was considered worse if it went from a grade of 3 to 4 and said to improve if it decreased by 1 grade or to a grade of 0.
Adalimumab was given to all patients by being injected under the skin every two weeks at a dose of 40 milligrams for children weighing at least 30 kilograms or 20 milligrams for children weighing less than 30 kilograms. Patients or their parents were taught by a nurse how to inject the treatment. If the treatment didn’t seem to be working after three months, the treatment frequency was changed to once per week.
The researchers saw an initial improvement in inflammation for 86 percent of study participants, with an average time to achieve this response of six weeks.
Treatment was found to be effective in 60 percent of patients, mildly effective in 13 percent of patients and ineffective in 13 percent of patients. The condition worsened in 13 percent of patients.
Among JIA patients, treatment was effective for 60 percent of patients, mildly effective for 20 percent of patients and ineffective for 20 percent of patients. Adalimumab therapy was discontinued for four patients.
According to the Ocular Immunology and Uveitis Foundation (OIUF), uveitis is the third leading cause of preventable blindness in America, and 5 to 10 percent of uveitis cases occur in children under the age of 16.
The OIUF states that it is important to know the symptoms of uveitis so that treatment can begin as soon as possible to minimize vision loss. These symptoms may include pain or redness in the eye, sensitivity to light, blurred or diminished vision, seeing black spots (called "floaters") and abnormal eye movement or alignment.
The authors of this study concluded that adalimumab seemed to be effective during the initial stages of treatment for pediatric refractory uveitis, but became less effective as time went on.
This study was published on October 22 in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.
The study authors reported no competing interests.