VALENCIA, Spain – More than half of patients with juvenile idiopathic arthritis who also had uveitis had a good or moderate response to long-term adalimumab treatment, a study has shown.
By the end of the 24-month follow-up period, 35% (17) of these patients did not need any additional local treatment for their eye disease, Dr. Hanna Saila reported, in presenting the study results at the 17th European Pediatric Rheumatology Society Congress.
Another 35% (17) needed to use 1-2 corticosteroid drops per day in addition to their adalimumab treatment, while the remaining children, who still had active eye disease, used three or more drops per day.
Dr. Saila and her colleagues also observed that the arthritis symptoms in patients with both disorders tended to be more refractory to treatment than those in patients who did not also develop uveitis.
She presented the results of a 24-month prospective study of 94 children with active juvenile idiopathic arthritis (JIA), 49 of whom also had active uveitis. All of the children were started on a treatment regimen of 20-40 mg adalimumab per week. In 18 of the JIA patients without uveitis, the drug was withdrawn, she reported at the congress.
Most of the patients (52) were girls. The mean age at arthritis diagnosis was 4.5 years in patients with uveitis, versus 7 years in those without. In the group without eye disease, 9 of the 27 patients (33%) had oligoarthritis, 16 (59%) polyarthritis, and 2 (7%) psoriatic arthritis.
Among those with uveitis, 29 had oligoarthritis, 17 had polyarthritis, and 3 had psoriatic arthritis. HLA B27 positivity occurred in 10 (20%), while 33 (67%) were positive for antinuclear antibodies (significantly more than those without eye disease). The mean age at onset of eye disease was 5 years; by the time children were enrolled in the trial, they had had uveitis for a mean of 9 years.
The researchers evaluated the activity of uveitis at the beginning of treatment, and at the end, using the Standardization of Uveitis Nomenclature (SUN) criteria. Arthritis activity was evaluated by the number of swollen or active joints both at the onset of adalimumab therapy and at the end of the study.
There was a 19% adalimumab discontinuation rate during the study (18 patients). Two patients restarted therapy with good results. Fifteen patients discontinued for inefficacy; one each discontinued for vasculitis, cutaneous eruption, and remission.
By the end of the study, among the 49 patients with eye disease, 14 (29%) had a good response according to the SUN criteria, 15 (31%) had a moderate response, 13 (27%) had no change, and 7 (14%) were worse. In the 34 patients who achieved clinical control of their eye disease, 17 had no need of ophthalmic corticosteroids, and 17 needed 1-2 drops/day. The 15 children with active uveitis still used 3 or more corticosteroid drops per day.
Dr. Saila also examined adalimumab's effect on arthritis. At the beginning of the study, there was no significant difference in swollen or active joints between those with and without uveitis (34 vs. 25; 69% vs. 93%). At the study’s end, significantly more patients without eye disease were in remission with medication (36 vs. 11; 73% vs. 41%) and significantly fewer had swollen or active joints (13 vs. 16; 27% vs. 59%).
At the end of the study, significantly more patients with eye disease were taking methotrexate (30 vs. 9; 61% vs. 33%), but prednisone was used equally between the groups (9 vs. 5; 18% vs. 19%).
Disclosures: Dr. Saila had no financial disclosures.