Rates of cataracts and glaucoma trended higher in the group controlled on infliximab than on adalimumab Q1 week, although this did not reach statistical significance. also includes adalimumab Q1 week as a treatment option.6 However, the efficacy of Q1 week dosing of Rabbit polyclonal to ZNF697 adalimumab in children has not been evaluated formally. We conducted a single-center review to assess the effectiveness of adalimumab Q1 week in treating uveitis refractory to adalimumab Q2 weeks, compared with patients switched to infliximab, a chimeric monoclonal antiCTNF- antibody administered intravenously, as reference. METHODS We conducted a review of medical records from children with chronic noninfectious uveitis treated with adalimumab Q2 weeks who switched to adalimumab Q1 week or monthly infliximab due to persistent uveitis. Medical records for patients seen in the Boston Children’s Hospital Rheumatology Clinic between 2000 and 2018 with an or code of uveitis were reviewed for inclusion. Patients were included if they had a confirmed diagnosis of noninfectious uveitis on review of rheumatology and ophthalmology notes, use of adalimumab Q2 weeks with persistent active uveitis (defined as 1+ anterior chamber cells, use of 2 drops of topical prednisolone acetate 1% daily, or active uveitis documented in rheumatology or ophthalmology notes), and subsequent switch to adalimumab Q1 week or monthly infliximab due to persistent uveitis. Patients were excluded if rheumatology and ophthalmology notes were unavailable for review or if it was not clear that the reason for medication change was due to uveitis activity. Patient records were reviewed for patient age at diagnosis of uveitis, uveitis characteristics Donepezil at presentation including laterality, compartments involved, degree of inflammation at presentation, diagnosis of JIA or other rheumatologic disease, and uveitis course including medications, time to control, ocular complications, and uveitis recurrence. The primary outcome was proportion achieving uveitis Donepezil control, defined as no anterior chamber cells or trace/1 to 5 anterior chamber cells (grade 0.5+), or documentation in rheumatology or ophthalmology notes of remission or uveitis control on 1 drop or more per day of topical prednisolone acetate 1% for 30 days. Secondary outcomes included time to uveitis control, uveitis recurrence while on therapy, and complications including glaucoma and cataracts. Uveitis recurrence was defined as more than 5 anterior chamber cells (grade 1+) on slit lamp examination or uveitis recurrence necessitating change in therapy as documented in notes. Statistical comparisons between groups were performed using Fisher exact test or Mann-Whitney test as appropriate. A or code of uveitis and use of adalimumab. Of these, 85 were confirmed to have clinical diagnosis of noninfectious uveitis by review of rheumatology and ophthalmology visit notes, and 69 had been treated with adalimumab Q2 weeks. Of these, 34 patients had been switched directly from adalimumab Q2 weeks to adalimumab Q1 week or monthly infliximab. One patient was excluded due to insufficient documentation available. Nine patients were excluded because the switch in biologic therapy was made for an indication other than persistent uveitis, such as arthritis flare. The remaining 24 patients were determined via chart review to have been switched to either infliximab or adalimumab Q2 weeks for reason of persistent uveitis and were included in our cohort. Patient Cohort Of 24 pediatric patients on adalimumab Q2 weeks, 19 were switched to adalimumab Q1 week and 5 were switched to infliximab (Fig.). Twelve (63%) of 19 patients achieved uveitis control after switching to adalimumab Q1 week, compared with 4 (80%) of 5 who switched to infliximab (= 0.63). All 7 patients who did not respond to adalimumab Q1 week were subsequently switched to infliximab, on which 5 (71%) were controlled. Open Donepezil in a separate window FIGURE. Patient cohort. Flowchart indicating the number of patients with refractory uveitis who switched from adalimumab Q2 weeks to each arm of the study (adalimumab Q1 week or infliximab) and the portion who achieved disease control on the indicated medications. Patients switched initially to adalimumab Q1 week did not differ from those switched initially to infliximab in terms of demographic or uveitis characteristics (Table 1). The majority of patients were female (71%). The median age of uveitis diagnosis was 6.5 years, and the median age at switching biologic therapies was 10.9 years. Patients were on adalimumab Q2 weeks for amedian of 10.4 months before switching to adalimumab Q1 week versus 16.1 months before switching to infliximab ( 0.99). There was no significant difference between ANA positivity between the 2 groups. Most patients had JIA (71%), whereas 4 (17%) had other rheumatologic diagnoses including Blau syndrome, psoriasis (without JIA), Vogt-Koyanagi-Harada disease, and tubulointerstitial nephritis and uveitis syndrome. The majority of patients in both groups received topical steroids and adjunctive disease-modifying antirheumatic drugs before switch from adalimumab Q2 weeks (Table 1). Five patients (4 from adalimumab Q1 week group and 1 from the infliximab group) had previously been treated with infliximab before initiating adalimumab Q2 weeks for uveitis; however, their initial discontinuation of infliximab was due to.