Efficacy of Adalimumab Therapy for Non-Infectious Uveitis in Japanese Patients: Methotrexate Concomitance Across Different Uveitis Etiologies and the Effect of Dose Spacing.

PURPOSE: To evaluate the long-term efficacy of adalimumab (ADA) in Japanese patients with non-infectious uveitis (NIU), with particular attention to etiologic differences in methotrexate (MTX) requirements and the feasibility of ADA dose spacing.

METHODS

This retrospective study included patients with chronic NIU or sclerouveitis treated with ADA for more than 6 months. Data included ocular inflammation control, systemic corticosteroid dose, and MTX use. The prespecified primary time point was 12 months. The primary endpoints were patient-level inactive uveitis and change in oral corticosteroid dose. Eye-level outcomes were analyzed using mixed-effects models and generalized estimating equations. Survival analysis compared MTX requirements among etiologies, and dose spacing outcomes and adverse events were also assessed.

RESULTS

Eighty-three patients (160 eyes) were included in this study. ADA reduced systemic corticosteroid dosage (mean 13.7 mg/day at baseline to 0.9 mg/day at 12 months; Wilcoxon signed-rank test p < 0.0001 for baseline-to-12-month change) and improved best-corrected visual acuity (mixed-effects model: p = 0.035 at 12 months) and inflammation markers. Inactive uveitis was observed in 61.5% (48/78) at 12 months. Patients with late- or chronic-stage Vogt-Koyanagi-Harada disease/sympathetic ophthalmia showed a trend toward a higher requirement for MTX concomitance than Behçet's disease patient. Over half of the 24 patients attempting dose spacing relapsed (14/24), but disease control was regained by shortening intervals. The median relapse-free survival was 20.8 months (95% CI 14.5-25.2).

CONCLUSION

ADA effectively controlled NIU and provided significant steroid-sparing benefits. Possible etiology-dependent differences in MTX requirements and relapse risk during dose spacing, support the optimization of individualized, closely monitored treatment.