Several factors must be considered when tapering adalimumab in noninfectious uveitis patients

For patients who undergo adalimumab tapering after achieving remission, factors such as age, race, and duration of disease remission on adalimumab appear to impact the risk of relapse, according to a study.

For this retrospective study, researchers looked at the medical records of 328 patients (mean age 34.3 years, 54.6 percent women) with noninfectious uveitis who were treated with adalimumab and subsequently underwent tapering. They collected data on patient demographics, type of noninfectious uveitis, onset and duration of disease, period of inactivity before tapering adalimumab, and tapering schedule.

The mean time between disease onset and initiation of adalimumab therapy was 35.2 weeks. Adalimumab tapering began after a mean of 100.8 weeks of disease inactivity. Recurrence occurred in 39.6 percent of patients at a mean of 44.7 weeks.

Patients who experienced recurrence were much younger than those who remained on remission (mean 29.4 vs 37.5 years; p=0.0005), and the rate of recurrence was significantly higher among younger patients (hazard ratio [HR], 0.88 per decade of increasing age; p=0.01). Asian patients had the lowest rate of recurrence.

Of note, a faster adalimumab taper was associated with an increased recurrence rate (HR, 1.23 per unit increase in speed; p<0.0005). On the other hand, an extended period of remission prior to tapering was protective against recurrence (HR, 0.97 per 10-weeks longer period of inactivity; p=0.04).

The findings suggest that several factors, such as age, race, and duration of disease remission on adalimumab, may influence recurrence risk of noninfectious uveitis following remission on adalimumab. Furthermore, a slow tapering schedule is advisable.