Factors Associated with Adalimumab Initiation in Non-Infectious Uveitis: A Propensity Score Matched Analysis.

PURPOSE: To identify factors associated with adalimumab initiation in non-infectious uveitis.

METHODS

This was a retrospective case-control study using multicentric data of 3204 patients. The primary outcome was whether adalimumab was initiated, and the secondary outcome was time to initiation. To investigate factors influencing the primary outcome, propensity score matching (1:3) of adalimumab recipients (n = 53, cases) to non-recipients (n = 159, controls) was done to reduce confounding by age, sex, race, anatomical category of disease, and follow-up time. Subsequently, subgroup analysis was performed among adalimumab recipients to investigate factors influencing time to initiation. Statistical methods included logistic regression and survival analysis of time to adalimumab initiation.

RESULTS

Factors which predicted for the primary outcome of adalimumab initiation included mixed autoimmune-autoinflammatory etiologies (multivariable OR = 3.97, CI: 1.37-12.21, p = 0.012) such as juvenile idiopathic arthritis (JIA), psoriasis and Behcet's disease, as well as the presence of retinal vasculitis (univariable OR = 2.10; CI: 1.06-4.09). Secondarily, among the 53 patients initiated on adalimumab, bilateral disease (adjusted survival HR = 2.07; CI: 1.08-3.98) and posterior uveitis (adjusted univariable logistic OR = 9.44; CI: 1.01-88.18) were associated with earlier adalimumab initiation, while the presence of keratic precipitates showed association with late adalimumab initiation (adjusted univariable OR = 0.18, CI: 0.03-0.93).

CONCLUSION

Uveitis patients with underlying mixed autoimmune-autoinflammatory etiologies (specifically JIA, and likely Behcet's disease and psoriasis), and those with retinal vasculitis were more likely to be initiated on adalimumab. Bilateral or posterior disease may also influence earlier adalimumab initiation. Therefore, clinicians who encounter these phenotypes at patients' first presentation may wish to anticipate early escalation to adalimumab.