Adalimumab Observed to Prevent Blindness in Children with Arthritis

A combination of commonly used drugs may be able to prevent children with arthritis from developing serious complications, such as blindness, according to a study published by the New England Journal of Medicine.

Thousands of children with juvenile idiopathic arthritis will develop uveitis, which is characterized by inflammation of the middle layer of the eye. This can lead to blurred vision and blindness, which may result in a reduced quality of life, especially in children.

"Uveitis in children is an important cause of loss of vision. This study demonstrates the benefit of adalimumab in children with uveitis,” said co-chief investigator Athimalaipet Ramanan, FRCPCH, FRCP. “This is the first randomised [sic] trial of its kind worldwide and the results will have a major impact in children with uveitis all around the world."

Included in the study were 149 patients with juvenile idiopathic arthritis-related uveitis. The authors found that adalimumab (Humira) in combination with methotrexate effectively treated patients with the condition. Adalimumab is an anti-inflammatory drug that has been approved to treat numerous autoimmune and inflammatory conditions, while methotrexate has been approved to treat cancers and autoimmune conditions.

Approximately 75% of patients treated with adalimumab experienced a reduction of eye inflammation, according to the study. An interim analysis revealed such positive results that the trial was stopped early.

The data and safety monitoring committee reported that patients treated with adalimumab had a substantially lower risk of treatment failure compared with the placebo group, according to the study.

The clinical trial requires collaboration between pediatric, rheumatology, and ophthalmology colleagues in the UK. This first of its kind study represents a significant improvement in the treatment of juvenile idopathic arthritis.

Notably, the findings led to a change in commissioning guidelines and resulted in NHS England to approve adalimumab in children with sight-threatening uveitis, according to the study.

"This landmark trial has demonstrated the commitment and leadership of colleagues across the UK in working closely with patients and parents in tackling a key priority of finding the very best way of caring for children with arthritis and this serious problem of uveitis,” said co-chief investigator Michael Beresford, PhD.

In the UK alone, there are 15,000 children and adolescents with juvenile idiopathic arthritis (JIA). Since approximately one-third will develop uveitis, the discovery that an approved and widely used treatment — adalimumab – can effectively treat the condition, means less patients will likely experience vision loss.

"We're thrilled of the outcome of this trial and the huge promise it heralds for transforming the quality of life for the large numbers of children with JIA-associated uveitis,” said Stephen Simpson, director of research and programs at Arthritis Research UK. "This trial is an impressive example of how investing in exceptional science can ultimately help change how treatment is delivered with direct and immediate benefit for patients."