TOPLINE:

In patients with active, refractory noninfectious uveitis, anakinra proved ineffective and was discontinued, whereas adalimumab and tocilizumab provided similar control of intraocular inflammation and enabled tapering of prednisone to 0.1 mg/kg per day or less by week 16.

METHODOLOGY:

• Researchers conducted a clinical trial across 27 French centers to evaluate the efficacy and safety of adalimumab, anakinra, and tocilizumab in 112 patients with active and refractory noninfectious uveitis (median age, 48.9 years; 55% women).
• Participants were randomly assigned to receive subcutaneous adalimumab (n = 44; an initial dose of 80 mg, followed by 40 mg every 2 weeks), anakinra (n = 18; 100 mg daily), or tocilizumab (n = 50; 162 mg weekly) for 16 weeks.
• All patients followed a standardized corticosteroid regimen: 0.5 mg/kg per day of prednisone equivalent for 4 weeks, followed by a gradual taper to a target of 0.1 mg/kg per day or less between weeks 12 and 16 if no relapse of uveitis occurred.
• The primary endpoint was a reduction of at least two steps on the Miami nine-step scale for vitreous haze — a standardized grading system for vitreous inflammation — while maintaining a prednisone dose of 0.1 mg/kg per day or less at week 16.

TAKEAWAY:

• Anakinra was ineffective, and this treatment was stopped prematurely.
• The proportion of patients achieving the primary endpoint was comparable between the patients receiving adalimumab (seven of 44; 16%) and tocilizumab (seven of 50; 14%; mean difference, -2%; 95% credible interval [CrI], -16.8% to 12.3%).
• At week 16, 48% of patients in the adalimumab group and 54% in the tocilizumab group achieved resolution of macular edema (posterior mean difference [tocilizumab − adalimumab], +6.1%; 95% CrI, -13.5 to 25.5).
• Mild-to-moderate adverse events occurred in 43% of patients receiving adalimumab and in 54% of patients receiving tocilizumab.

IN PRACTICE:

“Adalimumab and tocilizumab used as corticosteroid-sparing treatment showed comparable efficacy…further research is needed to determine if either drug is more effective on specific uveitic complications,” the researchers reported.

SOURCE:

This study was led by David Saadoun, MD, PhD, of the Department of Internal Medicine and Clinical Immunology at Sorbonne Université in Paris. It was published online on February 3, 2026, in the American Journal of Ophthalmology.

LIMITATIONS:

The open-label design was a limitation. The 16-week duration of this study restricted the ability to assess disease control and durability of response over long-term follow-up periods. The heterogeneity of noninfectious uveitis subtypes included in the study was an additional limitation.

DISCLOSURES:

This study received support from the French Ministry of Health through Programme Hospitalier de Recherche Clinique 2015. The authors reported no relevant conflicts of interest.

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