Gradual adalimumab tapering minimizes uveitis recurrence in children

In children with noninfectious uveitis being treated with adalimumab, tapering speed appears to affect the risk of relapse, with a slow, gradual approach emerging as the optimal strategy, according to a multicentre retrospective cohort study.

The study included 114 paediatric patients (57 percent female) with noninfectious uveitis who underwent adalimumab tapering due to disease inactivity. Risk factors for uveitis recurrence was examined using Cox proportional hazards regression.

Of the patients, 46 percent had juvenile idiopathic arthritis-associated uveitis (JIA-U) and 40 percent had idiopathic uveitis. Recurrence occurred in 46 percent of the patients overall at a median of 30 weeks after the initiation of adalimumab tapering. Those who did not experience recurrences were followed for a median of 70 weeks.

A slower adalimumab tapering schedule was associated with a 60-percent reduction in the risk of recurrence (hazard ratio [HR], 0.40, 95 percent confidence interval [CI], 0.21–0.74; p<0.01). In the subgroup of patients with juvenile idiopathic arthritis-associated uveitis, initiating adalimumab tapering after at least 2 years of disease inactivity significantly decreased the risk of recurrence (HR, 0.65, 95 percent CI, 0.43–0.95; p=0.05).

Finally, among 59 patients who discontinued adalimumab, recurrence rates did not significantly differ between fast and slow tapering groups (21 percent vs 33 percent, respectively; p=0.6). However, recurrence occurred sooner in the fast tapering group (10 vs 37 weeks; p=0.05).

The findings support a gradual, slow tapering approach with close monitoring.