Does adalimumab prevent the loss of visual acuity in patients with uveitis?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not adalimumab prevents the loss of visual acuity in patients with uveitis. STUDY DESIGN: Review of three English language primary studies published between 2013-2016. DATA SOURCES: Two randomized controlled phase 3 trials and one retrospective study were found using PubMed. The RCT’s compared treatment with adalimumab to placebo in patients with noninfectious uveitis, while the retrospective study solely assessed outcomes in patients with noninfectious uveitis receiving adalimumab treatment. OUTCOMES MEASURED: For the two RCT’s, the clinical outcome of time to treatment failure due to worsening visual acuity was measured by calculating logMAR from the Early Treatment Diabetic Retinopathy Study (EDTRS) chart in each eye. For these two studies visual Functioning questionnaires (VFQ-25) were also administered. In the retrospective study visual acuity was measured using Snellen charts. RESULTS: The randomized controlled phase 3 trials found a statistically significant decrease in treatment failure due to a worsening of visual acuity in the patients treated with adalimumab over placebo. In Jaffe et al. the mean change in best corrected visual acuity (BCVA) was significantly less for the adalimumab group, however, in Nguyen et al the difference was not statistically significant. The VFQ-25 was in favor of the adalimumab group in both studies but was not significant in Nguyen et al. A larger number of serious adverse events were associated with the adalimumab group compared to placebo, but no new safety issues were identified. The retrospective study also showed improvement in visual outcomes for noninfectious uveitis patients treated with adalimumab. CONCLUSION: Adalimumab can help prevent loss of visual acuity in adult patients with noninfectious intermediate, posterior or panuveitis