Recurrence Risk in Pediatric Non-Infectious Uveitis during Adalimumab Tapering: An International Multicenter Retrospective Study.

Objective: This study aims to assess the risk of non-infectious uveitis (NIU) relapse in pediatric patients undergoing Adalimumab (ADA) tapering, evaluating potential predictors of such risk

Methods: We conducted a multicenter retrospective cohort study involving pediatric NIU patients who underwent ADA tapering due to inactive uveitis. Cox proportional hazards regression was used to analyze risk factors for NIU recurrence.

Results: The study cohort comprised 114 patients (65 girls; 57%). Most commonly, patients presented juvenile idiopathic arthritis-associated uveitis (JIA-U) (52/114; 46%) or idiopathic uveitis (IU) (46/114; 40%). At ADA tapering, 46% (53/114) experienced NIU recurrence after an overall median time of 30 weeks [interquartile range (IQR) 15-58 weeks)] from the start of ADA tapering. Patients without recurrences were followed for a median of 70 weeks (IQR 48-98 weeks). Multivariate Cox regression analysis showed that a slower ADA tapering schedule was associated with a lower recurrence rate during the waning (hazard ratio [HR] 0.40; 95% CI 0.21-0.74; p < 0.01). Subgroup analysis of patients with juvenile idiopathic arthritis-associated uveitis (JIA-U) indicated that beginning ADA tapering after at least two years of disease inactivity significantly reduced recurrence risk (HR 0.65; 95% CI 0.43-0.95; p = 0.05). Among 59 patients (52%) who discontinued ADA, recurrence rates were similar between fast and slow tapering groups (21% vs. 33%; p=0.6), but median time to recurrence was shorter with fast tapering (10 weeks vs. 37 weeks; p=0.05).

Conclusions: This study highlights the significant clinical impact of ADA tapering on uveitis recurrence risk, recommending a gradual, slow tapering approach with close monitoring.