There was a low incidence of active tuberculosis, opportunistic infections, serious infections, and malignancies. Five patients experienced demyelinating disorders, a recognized association with intermediate uveitis, underscoring the importance of proper screening for these disorders prior to starting a TNF blocker in patients with intermediate uveitis or unexplained neurologic symptoms.
Only 5% of patients in VISUAL III discontinued adalimumab use for lack of efficacy during the study period, but the agent is not a cure-all. Of patients who entered the study with active uveitis, 40% were not quiescent at week 78 and 26% of those with inactive uveitis at week 0 were not quiescent at week 78.
“A majority of patients were able to maintain control of their uveitis with adalimumab and a majority were able to taper their corticosteroid doses significantly,” Dr. Suhler said. “This is one of those rare circumstances where an open-label study is, in some ways, more compelling than the two randomized trials that proceeded it.”
Why haven’t ophthalmologists flocked to adalimumab to treat non-infectious uveitis? Inertia and lingering doubts as to the safety of biologics are slowing adoption. “Ophthalmology has trailed other specialties by 15 to 20 years in the adoption of biologics,” Dr. Suhler continued. “Most of these agents were developed for rheumatology, transplant medicine, dermatology, gastroenterology, and other areas, and ophthalmologists just aren’t geared into using these agents from a knowledge, familiarity, or comfort standpoint.”
It is hoped that will change or, at the very least, ophthalmologists will develop relationships with other clinicians, such as rheumatologists or uveitis specialists, who are comfortable using biologics for uveitis. Long-term, high-dose corticosteroids reduce the quantity and the quality of patients’ lives. “We want to avoid that at all costs and adalimumab lets us do it,” he said.
ERIC B. SUHLER, MD
E: [email protected]
This article was adapted from Dr. Suhler’s presentation at the 2017 meeting of the American Academy of Ophthalmology. He did not indicate any financial interest.