Association Between Adalimumab Dosing Interval and Uveitis Recurrence in Patients with Ankylosing Spondylitis.

Background/

Objectives

Ankylosing spondylitis (AS) is a chronic inflammatory disease frequently associated with acute uveitis (AU). Adalimumab, a monoclonal tumor necrosis factor (TNF) inhibitor, is widely used to manage AS and AU. While biologic tapering is recommended in stable AS, its impact on uveitis recurrence remains unclear.

Methods

This real-world retrospective cohort study analyzed 65 AS patients with a history of AU who received adalimumab for ≥6 months. Time-dependent covariates, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and adalimumab dosing interval, were incorporated into a logistic regression model using generalized estimating equations to identify risk factors for uveitis recurrence. Uveitis recurrence rates were compared among different dosing intervals: every 2 weeks (q2w), every 3 weeks (q3w), and every 4 weeks or longer (q4w+).

Results

Among the 65 patients, 27 (41.5%) experienced a total of 50 AU flares during adalimumab treatment. Recurrence rates increased with dosing interval extension (1.5% for q2w, 3.6% for q3w, and 4.0% for q4w+; p = 0.036). In adjusted logistic analysis, the odds ratio (OR) for AU recurrence was significantly higher for q3w (OR = 3.766) and q4w+ (OR = 4.916) compared to q2w. Other factors, including age, sex, ESR, and BASDAI, were not significantly associated with uveitis recurrence.

Conclusions

Extended dosing intervals of adalimumab in AS patients with prior AU may be associated with a higher prevalence of uveitis recurrence, even when axial symptoms remain controlled. Therefore, adalimumab spacing strategies should be implemented with caution in these patients to minimize the risk of uveitis recurrence.