Adalimumab therapy demonstrates better efficacy and safety profiles compared with infliximab in the treatment of refractory juvenile idiopathic arthritis (JIA)-associated anterior uveitis in patients treated for at least 2 years, according to the results of a study using data from the Ocular Involvement in Childhood Rheumatic Diseases (ORCHIDEA) Registry published in The Journal of Rheumatology.  

Patients with JIA-associated anterior uveitis treated with infliximab or adalimumab were managed using a standardized protocol, and all data were entered into the ORCHIDEA registry. At baseline, all participants were refractory to standard immunosuppressive therapy or were corticosteroid-dependent. Data were compiled every 3 months on anterior uveitis course, number and type of ocular flares and complications, drug-related adverse events, and treatment switch or discontinuation.

A total of 154 participants with ≥24 months of follow-up were enrolled in the study, including 95 patients treated with adalimumab and 59 patients treated with infliximab. Clinical remission, which was defined as the absence of flares for >6 months on therapy, was attained in 44.8% of patients, with a significantly improved remission rate in adalimumab-treated patients vs infliximab-treated patients (60.0% vs 20.3%, respectively; P <.001).

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All patients reported a significant reduction in flares, with no significant difference reported between the two treatments. Although the number of new ocular complications declined in both arms, it was significantly lower with adalimumab therapy (P =.015). No serious adverse events were reported. Overall, 16.4% of participants experienced 35 minor adverse events, and the incidence of adverse events was lower in the adalimumab group compared with the infliximab group.

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The higher retention rates reported at 2 years with adalimumab vs infliximab (94.7% vs 54.2%; P <.001) may be explained by the lower incidence of minor adverse events, the easier and more comfortable drug administration, and the greater efficacy of adalimumab. The investigators concluded that at 2-year follow-up, adalimumab therapy demonstrated better efficacy and safety profiles compared with infliximab in the treatment of refractory JIA-associated anterior uveitis.

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Cecchin V, Zannin ME, Ferrari D, et al. Longterm safety and efficacy of adalimumab and infliximab for uveitis associated with juvenile idiopathic arthritis [published online April 15, 2018].  J Rheumatol. doi:10.3899/jrheum.171006