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Table 2 Clinical response and treatment efficacy of adalimumab in BD-related uveitis

From: Experience of using adalimumab in treating sight-threatening paediatric or adolescent Behcet’s disease-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
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
  1. ADA adalimumab, CS corticosteroid, CSA cyclosporine A, MMF mycophenolate mofentil, DMARDs disease-modifying antirheumatic drugs