Quiescence and Subsequent Anterior Chamber Inflammation in Adalimumab-treated Pediatric Noninfectious Uveitis

Purpose: To evaluate the effect of adalimumab in pediatric uveitis and subsequent changes in anterior chamber inflammationfollowing the inactivation of uveitis. Methods: In this retrospective study, patients with noninfectious uveitis younger than 18 years of age who were treatedwith adalimumab for more than 12 months were included. The rate of complete suppression and the relapse in anteriorchamber inflammation following the initiation of adalimumab therapy were evaluated using anterior chamber cell score andlaser flare photometry (LFP) values, if available. Changes in visual acuity and the sparing effect of topical steroid agents werealso evaluated. Results: Among 22 eyes of 12 pediatric uveitis patients enrolled, 13 eyes were associated with juvenile idiopathic arthritisand nine eyes had idiopathic uveitis. The mean ± standard deviation age was 10.2 ± 3.6 years. Types of uveitis included anterioruveitis (n = 17) and panuveitis (n = 5). Quiescence was observed in 14 eyes (63.6%) at 3 months and in 21 eyes (95.5%) at12 months after initiation, respectively. After achieving inactive uveitis, uveitis relapsed in two eyes at 6 months, even withadalimumab treatment. In 11 eyes, anterior chamber showed 0.5+ cell scores during the rest of the follow-up period and oneof those eyes met the criteria for the relapse based on LFP values. The dosage of topical steroids decreased significantly at3, 9, and 12 months after the initiation of therapy (p ≤ 0.05). Visual acuity did not show improvement. There were no severeadverse effects of anti-tumor necrosis factor-α treatment reported. Conclusions: In this study, adalimumab achieved a quiescent state in most eyes with pediatric noninfectious uveitis for 12months with a relapse rate of 9.5%. LFP values together with the anterior chamber cell score can be utilized to monitor theimprovement or relapse in anterior chamber inflammation in pediatric noninfectious uveitis.