New Study Probes Adalimumab Discontinuation for Juvenile Uveitis

Researchers, led by Dr. Nisha R. Acharya from the Francis I. Proctor Foundation at the University of California, San Francisco, have published a groundbreaking study on January 25, 2025, in The Lancet. This study explores the effects of continuing versus discontinuing adalimumab in children with juvenile idiopathic arthritis (JIA)-associated uveitis. Supported by the US National Institutes of Health's National Eye Institute, this randomized controlled trial involved 87 children aged 2 years and older across the United States, United Kingdom, and Australia.

The trial, conducted from March 2020 to February 2024, focused on patients who had maintained control over both arthritis and uveitis for at least a year prior to enrollment. Participants were randomly assigned to either continue their adalimumab treatment or switch to placebo injections that appeared identical. The study found that discontinuing adalimumab resulted in a significantly higher rate of treatment failure compared to those who continued with the medication—68% versus 14%, respectively. This increased risk of treatment failure was quantified by a hazard ratio of 8.7 (P <.0001), indicating a considerably greater likelihood of relapse in those who stopped the drug.

In contrast, continuing adalimumab was associated with a higher occurrence of COVID-19 infections at a rate of 50 events per 100 person-years, compared to just six events per 100 person-years in those who discontinued the drug. Notably, arthritis recurrence was reported in four patients in the adalimumab group and seven in the placebo group. Additionally, four serious adverse events were recorded among patients who continued with adalimumab.

The study highlighted that the median time to treatment failure in the placebo group was 119 days. However, all patients who restarted adalimumab after experiencing treatment failure successfully regained control over ocular inflammation within a median period of 105 days. The researchers also utilized the 27-joint Juvenile Arthritis Disease Activity Score as a secondary outcome measure to assess the overall impact.

"The high rate of relapse after stopping adalimumab calls into question current recommendations regarding the timing for attempting withdrawal,"

• Nisha R. Acharya, MD, Francis I. Proctor Foundation, University of California, San Francisco.