Stopping adalimumab in juvenile idiopathic arthritis-associated uveitis increases treatment failure risk, a recent study found.

In a multicenter, randomized controlled trial halted early after meeting prespecified interim criteria, researchers found that discontinuing adalimumab treatment in patients with juvenile idiopathic arthritis (JIA)-associated uveitis led to significantly higher rates of recurrence. Among 87 enrolled patients who had their arthritis and uveitis controlled for at least 1 year with adalimumab, 68% of those receiving placebo experienced treatment failure compared with 14% in the adalimumab group.

The study, published in The Lancet, involved patients aged 2 years or older from ophthalmology and rheumatology clinics across the U.S., United Kingdom, and Australia. The primary outcome, time to treatment failure, was defined as recurrence of either uveitis or arthritis. Treatment failure occurred at a median of 119 days for patients in the placebo group.

The trial was conducted across 20 clinics with patients receiving either adalimumab (20 mg for patients weighing <30 kg or 40 mg for patients weighing ≥30 kg) or placebo subcutaneously every 2 weeks for 48 weeks. Before or at the primary endpoint, 4 serious adverse events occurred in patients taking masked medication in the adalimumab group, with only 1 considered possibly related to adalimumab. The adalimumab group reported 226 non-serious adverse events (7.5 per person-year), while the placebo group had 115 non-serious adverse events.

Importantly, visual acuity was not compromised between groups (P=.68). Among patients who experienced treatment failure, the median time to re-establishing sustained control after restarting adalimumab was 105 days (IQR, 63-196).

"Discontinuing adalimumab led to higher rates of recurrence of uveitis, arthritis, or both in patients with previously controlled juvenile idiopathic arthritis-associated uveitis," said Nisha R. Acharya, MD, from Francis I. Proctor Foundation, University of California San Francisco. "However, all patients who had treatment failure successfully regained control of inflammation by the end of the 48-week study period after restarting adalimumab."

The study investigators suggest that while discontinuing adalimumab may result in higher recurrence rates of JIA-associated uveitis, all patients who had treatment failure successfully regained control of inflammation after restarting the medication. Full disclosures are available in the study.