Treatment of a large cohort of childhood chronic non‐infectious uveitis a multicentric large study: adalimumab versus methotrexate as first line therapy

Background Treatment of childhood chronic idiopathic uveitis (cCIU) is predominantly based on studies in Juvenile Idiopathic Arthritis associated uveitis and expert opinion. Our aim was to report the treatment outcomes of our cohort of cCIU. Methods Retrospective multicenter study involving the rheuma/ophthalmology units at Florence and Bristol. We included children with cCIU, who received at least one systemic treatment. Ocular inflammation and treatment response were assessed according to the standardized Uveitis Nomenclature (SUN). Findings 116 cCIU received at least one systemic treatment (93 methotrexate, 22 adalimumab, 1 mycophenolate), while 60 of them received an additional second‐line (45 adalimumab, 14 mycophenolate and 1 tocilizumab). Children treated with adalimumab (+/‐methotrexate) as first‐line were more likely to achieve remission than methotrexate alone (χ 2 31.35 p<0.001), furthermore children treated with methotrexate as first‐line relapsed earlier (χ 2 4.35 p0.043). Children receiving adalimumab were more likely to stop treatment for remission than methotrexate (χ 2 25.9 p<0.001). Regarding second‐line, children who started adalimumab(±methotrexate) were more likely to achieve remission than mycophenolate (χ 2 14.66 p0.005). Children with non‐anterior uveitis, conversely to the others, were more likely to achieve remission with adalimumab as first‐line than methotrexate (χ 2 32.3 p<0.001). Children with non‐anterior uveitis, but not children with anterior uveitis, were more likely to stop the first‐line treatment when receiving adalimumab than methotrexate (χ 2 18.56 p0.001) due to persistent remission. Interpretations Adalimumab shows promise as a potential first‐line therapy for cCIU, particularly for posterior segment uveitis. Although effective in anterior uveitis, methotrexate leads children to relapse earlier than adalimumab.