Predictors of Therapy Success in Weekly Adalimumab for Refractory Uveitis: A Retrospective Cohort Study

Purpose

To determine predictors of treatment success after dose escalation of adalimumab, including the measurement of anti-adalimumab antibodies as a predictor of success.

Design

Retrospective clinical cohort study.

Methods

Setting: Single-center academic institution. Study population: Patients with noninfectious uveitis who were inadequately controlled or developed recurrent disease on every other week adalimumab and required dose escalation or therapy modification. Observation procedures: Patients who had anti-adalimumab antibodies checked with resultant low to intermediate levels were compared with patients who had no testing performed before adalimumab dose escalation. Of note, patients with testing and resultant high levels of anti-adalimumab antibodies were not escalated. Predictors of escalation success and utility of antibody testing before escalation were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards models. Main outcome measures: Treatment success defined as anterior chamber grade ≤0.5+ cell, topical corticosteroids ≤1 drop/d, oral prednisone ≤5 mg/d, resolution of macular edema, and resolution of angiographic signs of inflammation without any addition or escalation of therapy.

Results

A total of 24 patients had antibodies tested with low to intermediate levels (average: 32.3 ng/mL, range: 0-154 ng/mL), whereas 41 did not have antibody testing. A greater treatment success rate after escalation was observed among the “low antibody” group compared with the “no testing” group (hazard ratio: 2.63, standard error: 1.19, P = .031, 95% CI: 1.09-6.37). Among the entire cohort, patients with panuveitis (n = 14) had a lower treatment success rate compared with the reference of anterior uveitis (n = 26) (hazard ratio: 0.09, standard error: 0.11, P = .05, 95% CI: 0.01-0.99).

Conclusions

Patients with low anti-adalimumab antibodies had a greater treatment success than patients in whom antibodies were not checked. This suggests a utility to checking antibodies before dose escalation and that low levels of antibodies may confer a success advantage. Overall, patients with panuveitis had a lower rate of success after escalation while patients with anterior uveitis patients had a very high rate of success suggesting that certain disease characteristics may guide clinicians when determining who to escalate versus changing therapy.