Clinical outcomes of weekly adalimumab in refractory non-infectious paediatric uveitis and the role of serum drug levels and anti-adalimumab antibodies

BACKGROUND/OBJECTIVES: Adalimumab (ADA) is a well-established treatment for refractory paediatric uveitis; however, some patients remain inadequately controlled on standard biweekly dosing. Weekly ADA injections are increasingly used, though evidence in paediatric cohorts remains limited. This study evaluates outcomes of escalation to weekly ADA in children with refractory uveitis and explores the relevance of serum drug levels and anti-ADA antibodies (AAA). SUBJECTS/METHODS: Patients with idiopathic uveitis at two tertiary centres in the UK treated with weekly adalimumab were retrospectively reviewed. Demographic, clinical and laboratory data were collected, including age at escalation, systemic diagnosis, serum ADA levels, AAA titres pre- and post-escalation, clinical response and complications. Treatment success was defined as ≤0.5+ anterior chamber cells and <2 drops/day of steroid eye drops at 3 months, or most recent follow-up where escalation occurred within 3 months of review. RESULTS: 15 patients were included. Mean age at escalation was 11 years (range: 3-17). 11 (73%) had a systemic diagnosis; most commonly juvenile idiopathic arthritis (60%). Median serum level pre-escalation was 10.1 mg/L (IQR: 7.8-11.9) and 18.1 mg/L (IQR: 14.8-22.1) post escalation. AAAs were detectable in 7/15 (47%) pre-escalation, 2/15 (13.3%) post-escalation. Success occurred in 10/15 (67%), with visual acuity stable and improved in 93%. No serious systemic adverse events were reported. CONCLUSIONS: Weekly ADA offers a safe and effective treatment alternative for children with refractory uveitis, including those with AAAs. These findings support its inclusion in future treatment pathways, though the predictive value of serum levels and AAAs remains uncertain and warrants further investigation.