Evaluating the Effectiveness of Escalating to Weekly Adalimumab Dosing for the Treatment of Non-infectious Uveitis: A Multi-Center Study.

PubMed ID: 41038454

Author(s): Pillar S, Thomas A, Hassman L, Chen H, Gangaputra S, Kopplin LJ, Boyd K, Moussa K, Pham DC, Tsui E. Evaluating the Effectiveness of Escalating to Weekly Adalimumab Dosing for the Treatment of Non-infectious Uveitis: A Multi-Center Study. Ophthalmology. 2025 Sep 30:S0161-6420(25)00606-2. doi: 10.1016/j.ophtha.2025.09.019. Online ahead of print. PMID 41038454

Journal: Ophthalmology, Sep 2025

PURPOSE To evaluate the effectiveness of adalimumab (ADA) dose escalation in patients with non-infectious uveitis who are inadequately controlled with standard dosing.

DESIGN Multi-center retrospective interventional case series.

PARTICIPANTS Patients with non-infectious uveitis active on standard biweekly ADA dosing who had treatment escalated to weekly ADA dosing at 6 tertiary referral centers.

METHODS Demographic data and clinical findings were assessed at the time of ADA dose escalation and 6-months later. Mixed model analysis was performed to analyze clinical outcomes and to assess predictive factors of success.

MAIN OUTCOME MEASURES Treatment success composite criteria included: (1) disease quiescence (≤0.5+ anterior chamber cell, ≤0.5+ vitreous haze, inactive retinal/choroidal lesions); (2) prednisone ≤7.5 mg/day; and (3) ≤2 drops/day of prednisolone or equivalent (4) no treatment discontinuation.

RESULTS Fifty patients (44.4±21.2 years old, n=35 female) from 6 tertiary referral centers were included. At 6 months following ADA escalation (median 184 days), 52% of patients had achieved treatment success. Specific inflammatory signs significantly reduced after ADA escalation included anterior chamber cell grade (p=0.025) and presence of active retinal/choroidal lesions (p=0.010). Prednisone was decreased from >7.5 mg daily to lower doses in 63% (p=0.015). The odds ratio for treatment success was 6.88 for patients with posterior uveitis (p=0.024) and 0.14 (p=0.005) for patients with panuveitis. The hazard ratio for treatment success was 3.73 (p=0.009) for eyes with active retinal vasculitis at the time of ADA escalation.

CONCLUSION Escalation from standard biweekly ADA dosing to weekly ADA dosing achieved treatment success in over half of the patients. Posterior uveitis predicts a favorable chance of success, whereas panuveitis conveys a lower success rate.