Adalimumab for childhood onset uveitis

Juvenile idiopathic arthritis (JIA)-associated uveitis is the most common cause of paediatric uveitis and is associated with significant visual morbidity.1 Despite considerable improvements in the treatment of JIA, most trials of biological agents in JIA excluded children with uveitis for methodological reasons. This has meant a limited evidence base and availability of biological therapies for paediatric uveitis. The ADJUVITE study2 published in this journal and the recently published SYCAMORE study3 both provide much needed evidence for use of biologics in children with uveitis. The ADJUVITE study2 randomised 32 patients with childhood onset anterior uveitis and an inadequate response to topical steroid and methotrexate (MTX), based on a laser flare photometry (LFP) reading of ≥30 photon units/ms, to fortnightly adalimumab or placebo. The primary outcome was response to treatment at the end of month 2, defined as a reduction of at least 30% of ocular inflammation on LFP with no worsening of anterior chamber cells or flare according to Standardised Uveitis Nomenclature (SUN) criteria.4 In the adalimumab group, 9/16 patients had a 30% reduction in flare on LFP compared with 3/15 in the placebo group, which was statistically significant, but as the authors acknowledge should be interpreted with some caution as the CI included 1. There was no significant reduction in anterior chamber cell scores. This small study, following on from the SYCAMORE trial,3 which was stopped early due to evidence of efficacy of adalimumab for JIA-associated uveitis, provides further support for the use of adalimumab in childhood uveitis. However, there are striking differences between the ADJUVITE …