“A three year (2018 to 2021) real-world outcome of Adalimumab therapy in non- infectious uveitis (intermediate, posterior and pan uveitis) at a Tertiary Hospital in UK”. No financial disclosures from any of the authors.
Author: Priti Kulkarni (United Kingdom)
Co-authors: Ikenna Ahuche, Modupe Sodeinde, Bharat Kapoor, Periyasamy Kumar
Purpose
Following the conclusion of Visual I and II trial in 2015, National Institute for Health and Care Excellence (NICE) approved Adalimumab for the treatment of non-infectious uveitis. We share here our experience on the use of adalimumab in uveitis with the aim of validating the results of the Visual I and II trial and assessing the safety and efficacy of adalimumab therapy in non-infectious uveitis in a real-world non randomized clinical setting.
Setting/Venue
Department of Ophthalmology, Leicester Royal Infirmary. Leicester. UK
Methods
Eleven adults with non-infective uveitis, in line with NICE recommendations, were started on treatment with adalimumab between February 2018 and March 2021. 10 patients had a follow-up of 12 months or longer. Data was collected from the hospital patients electronic records. We assessed for Best Corrected Visual Acuity using the LogMAR scale, anterior chamber and vitreous activity using Standardization of Uveitis Nomenclature (SUN) criteria, macular oedema using TOPCON Optical Coherence Tomography (OCT). Active choroiditis and vasculitis was assessed with indirect ophthalmoscopy and documented. The data were collected both prior to commencing treatment and at intervals up to twelve months after commencing treatment. All data were entered by the reviewing ophthalmologist on a Microsoft excel spread sheet.
Results
Sixty and forty percent of our patients received treatment comparable to the adalimumab arm of visual I and II studies respectively. Patients with cataract were not excluded. With none lost to follow up, injection site related discomfort was the only adverse effect noted. Time to treatment failure ranged from 1.5 months to ‘not available’ among those with active uveitis compared to that seen in the visual 1 study (3.0 to not available); none recorded in active uveitis, similar to the finding in the visual II study. We recorded time to macular oedema of 3 months in only one patient with active uveitis who had cataract surgery , comparable to a range of (2.6-15.9 months) seen in the visual I. None was seen with inactive uveitis. Despite two patients having cataract surgery , changes in BCVA in active uveitis were similar to that seen in visual I, but better in the right eye among those with inactive uveitis than in visual II (0.29 VS 0.01). We found a higher Vitreous haze response than in visual I (Right 0.33 vs 0.13; left 0.41 vs 0.11). We recorded a lower mean Change in AC activity compared to both visual I and II.
Conlusions
We consider our study size to be small and as such may be difficult to draw direct comparison with the primary or secondary outcomes of the visual I or II studies but our findings were in line with the efficacy and safety of both studies. Our study is drawn from a clinical real world experience and not at variance with the results of the visual I and II studies even in a study size about ten percent smaller than either study, which may be a similar scenario in a clinical real world practice in other centers. We also show that cataract surgery (done while receiving adalimumab for two patients with pretreatment active uveitis) may not give results which are none-similar to those of the primary or secondary outcomes of the visual 1 or 2 studies in a smaller study size. We however recommend more studies and reports of real world clinical outcomes with larger study size and longer duration of follow up.
Financial Disclosure
None with regards to this presentation.
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