Table 2 Clinical response and treatment efficacy of adalimumab in BD-related uveitis
Patient no. | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|
Before adalimumab (ADA) treatment | |||||
Uveitis presentation | Bilateral intermediate uveitis | Bilateral panuveitis | Bilateral panuveitis | Bilateral posterior uveitis | Bilateral posterior uveitis |
Retinal vasculitis | No | Yes | Yes | Yes | Yes |
VA of OD, OS | OD 20/120, OS 20/120 | OD 20/30, OS HM | OD 20/60, OS 20/40 | OD 20/200, OS 16/200 | OD 20/60, OS 20/40 |
No. of relapses per year | 7 | 3 | 6 | 5 | 4 |
CS dosage prior to ADA treatment (mg) | 10 | 20 | 70 | 40 | 60 |
CS-related complications | Cushingoid features Adrenal insufficiency Short stature | Short stature Osteoporosis | Nil | Cushingoid features | Cushingoid features |
Concomitant DMARDs use at baseline | CSA 50 mg BD AZA 75 mg daily | CSA 50 mg BD AZA 75 mg daily | CSA 125 mg BD MTX 20 mg daily | CSA 50 mg BD AZA 75 mg daily | CSA 75 mg BD AZA 100 mg daily |
Intolerability/side effects of DMARDs | Borderline HT | Intolerant to AZA due to abdominal pain | Nil | Borderline raised creatinine level | Nil |
Ocular complication from BD-uveitis | Bilateral glaucoma Bilateral cataract | OS tractional retinal detachment | OS branch retinal artery occlusion | OS tractional retinal detachment | OD retinal neovascularization |
Operation performed related to complication | Bilateral cataract operation OS trabeculectomy | OS vitrectomy and TRD repair | OS retinal laser therapy | OS vitrectomy and TRD repair | Nil |
During adalimumab treatment | |||||
Status of retinal vasculitis | NA | Subsided | Subsided | Subsided | Subsided |
VA of OD, OS | OD 20/40, OS 20/40 | OD 20/20, OS HM | OD 20/16, OS 20/16 | OD 20/30, OS 8/200 | OD 20/30, OS 20/16 |
Time to control of activity | 2 weeks | 4 weeks | 3 weeks | 2 weeks | 2 weeks |
No. of relapses in first year (0–12 months) | 3 | 1 | 0 | 0 | 0 (0–6 months data only) |
No. of relapses in second year (12–24 months) | 3 | 0 | 3 | 2 | NA |
Nature of relapses | Anterior uveitis | Mild vitritis | Vitritis, focal retinitis, vasculitis causing BRAO | Vitritis | NA |
CS dosage at 6 months after initiation of ADA | 1 mg alt day (for adrenal insufficiency) | 10 mg | 9 mg | 10 mg | 7.5 mg |
Change of concomitant DMARDs | Nil | Reduction in dosage of CSA and MMF | Nil | Halved dosage of CSA | Nil |
Treatment for flare up | Topical steroid drops | Nil | High-dose oral steroid (1 mg/kg/day) | Controlled by increasing oral steroid | Nil |
Remission | Yes | Yes | No | Yes in first 12 months | Yes |
Long-term follow-up | |||||
Adalimumab treatment duration | 40 months | 25 months | 24 months | 41 months | 7 months |
Adalimumab discontinuation | No | Yes (remission) | No | No | No |
Relapse after adalimumab discontinuation | NA | No | NA | NA | NA |
Length of follow-up from adalimumab initiation | 40 months | 36 months | 38 months | 41 months | 7 months |