A new study shows that discontinuing adalimumab treatment in patients with juvenile idiopathic arthritis (JIA)-associated uveitis leads to a significantly higher risk of relapse compared to continuing treatment. While patients can regain control of inflammation after restarting adalimumab, the findings challenge current recommendations on withdrawal timing.
Discontinuing adalimumab treatment leads to a higher relapse rate in juvenile idiopathic arthritis ( JIA )-associated uveitis patients. A recent randomized controlled trial conducted across the United States, United Kingdom, and Australia, sheds light on the implications of stopping adalimumab in patients who have achieved clinical remission. The study involved 87 children aged 2 years or older with JIA -associated uveitis, enrolled from March 2020 to February 2024.
All participants had controlled arthritis and uveitis for at least a year before joining the trial. The children were randomly assigned to either continue receiving adalimumab, administered subcutaneously every two weeks in weight-adjusted doses, or to discontinue adalimumab and receive placebo injections that looked identical. Those who discontinued adalimumab experienced a significantly higher rate of treatment failure compared to the group that continued treatment (68% vs 14%), as defined by the recurrence of uveitis or arthritis. The median time to treatment failure for the placebo group was 119 days, while all patients who restarted adalimumab after experiencing treatment failure, regardless of their initial group assignment, regained control of their ocular inflammation within a median time of 105 days. This control was sustained throughout the follow-up period. Notably, arthritis recurrence was observed in four patients in the adalimumab group and seven patients in the placebo group. The study also reported four serious adverse events in the adalimumab continuation group. Interestingly, a higher rate of COVID-19 infections was observed in patients who continued adalimumab compared to those who discontinued it (50 vs 6 events per 100 person-years). The findings of this study challenge current recommendations regarding the timing of adalimumab withdrawal attempts. The authors emphasize that these results can guide the counseling of patients and families considering discontinuation of adalimumab therapy
ADALIMUMAB JIA UVEITIS RELAPSE CLINICAL TRIAL
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