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TOPLINE:

Slower tapering of adalimumab reduced the recurrence risk for noninfectious uveitis by 60% in pediatric patients compared with faster tapering, and starting the tapering after at least 2 years of disease inactivity notably reduced the recurrence risk for juvenile idiopathic arthritis–associated uveitis.

METHODOLOGY:

• Researchers conducted a multicenter, retrospective cohort study to evaluate the risk for relapse in pediatric patients with noninfectious uveitis who underwent adalimumab tapering due to inactive disease, while also examining potential predictors of this risk.
• They included 114 pediatric patients (57% girls; median age at disease onset, 5.6 years) with noninfectious uveitis who underwent adalimumab tapering, with juvenile idiopathic arthritis–associated uveitis and idiopathic uveitis accounting for 46% and 40% of cases, respectively.
• Patients received adalimumab subcutaneously every 2 weeks based on their weight, with tapering initiated after at least 26 weeks of persistent disease inactivity; tapering schedules were classified as “slower” (increasing injection intervals by 1 week every 4 months or more; n = 60) or “faster” (increasing intervals by 1 week every 3 months or less or 2 weeks every 4 months; n = 54).
• Uveitis recurrence was defined as an increase in the anterior chamber cell grade, vitreous haze, or the emergence of new active inflammatory chorioretinal or retinal lesions in one or both eyes after adalimumab tapering began.
• Patients were followed for a median duration of 70 weeks if no recurrences occurred.

TAKEAWAY:

• After an overall median duration of 30 weeks from the start of adalimumab tapering, 46% of patients had recurrence, with 56% and 38% of recurrences occurring in the fast-tapering and slow-tapering groups, respectively.
• A slower adalimumab tapering schedule was associated with a 60% lower recurrence risk than a faster adalimumab tapering schedule (hazard ratio [HR], 0.40; 95% CI, 0.21-0.74), with a more prominent association observed in patients with idiopathic uveitis (HR, 0.18; 95% CI, 0.06-0.59).
• For patients with juvenile idiopathic arthritis–associated uveitis, beginning adalimumab tapering after at least 2 years of disease inactivity significantly reduced the recurrence risk (HR, 0.65; 95% CI, 0.43-0.95).
• Among the 59 patients who discontinued adalimumab, recurrence rates were similar between fast-tapering and slow-tapering groups (P = .6), whereas the median time to recurrence was significantly shorter with fast tapering than with slow tapering (10 vs 37 weeks).

IN PRACTICE:

“Slow tapering translates into a longer relapse-free time, both during therapy reduction and after discontinuation complete drug,” the authors wrote.

SOURCE:

The study was led by Achille Marino, MD, PhD, Unit of Pediatric Rheumatology, ASST G. Pini-CTO, Milan, Italy. It was published online on April 2, 2025, in Arthritis & Rheumatology.

LIMITATIONS:

According to the authors, the multicenter nature of the study implies potential differences in noninfectious uveitis management among participating centers. The involvement of only tertiary centers may have introduced selection bias, potentially limiting representation to more severe cases. Additionally, the frequency of ophthalmologic follow-ups could be influenced by the tapering modality, potentially affecting the timing of recurrence detection.

DISCLOSURES:

No specific funding was received for this study. Some authors disclosed receiving honoraria, consultancy fees, speaker fees, travel expenses, and other ties with various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.