Adalimumab showed better long-term safety and efficacy results compared to infliximab in the treatment of juvenile idiopathic arthritis (JIA)-associated uveitis, or the inflammation of the eye’s middle layer, an Italian study reports.

Children taking adalimumab (sold under the brand name Humira, Exemptia, and others) had a lower number of new ocular complications and adverse events, along with a higher absence of ocular flares, compared to the group treated with infliximab (sold under the brand name Remicade and others). Ocular flares are a foggy appearance of the eyes caused by protein leaking from inflamed blood vessels.

The long-term data was reported in the study “Longterm safety and efficacy of Adalimumab and Infliximab for uveitis associated with juvenile idiopathic arthritis,” published in The Journal of Rheumatology.

Anterior uveitis is the most common extra-articular JIA symptom in children. It remains a medical challenge due to the lack of standardized treatments.

Uveitis treatment includes the administration of corticosteroids and biological agents, including adalimumab and infliximab.

Both adalimumab and infliximab are anti-tumor necrosis factor (TNF)-alpha agents designed to suppress the response of TNF, an important player in the inflammatory response. In 2007, the Italian Medicines Agency approved the use of both therapies as off-label treatments for refractory JIA-associated uveitis.

To overcome a lack of data regarding the long-term safety and efficacy of these biological agents, a national Italian registry was created called ORCHIDEA.

This new study assessed the safety and efficacy of adalimumab and infliximab for the treatment of JIA-associated uveitis in patients treated for at least two years. A total of 154 patients were included in the study through December 2014, all of whom were refractory, or unresponsive, to standard immune suppressors or were corticosteroid-dependent. Data related to these patients were entered in the ORCHIDEA registry.

Of 154 patients, 95 were treated with adalimumab and 59 were treated with infliximab.

The absence of flares for more than six months on treatment, defined as clinical remission, was observed in 69 patients (44.8 percent), with better remission in the adalimumab-treated group (60 percent) than the infliximab group (20.3 percent).

The number of new eye complications decreased in both groups, with lower values registered for adalimumab-treated patients (38 complications in 26.7 percent of patients) than the infliximab group (25 complications in 40.6 percent of patients).

Although a significant reduction in flares was achieved in both groups, no differences were observed among them.

Researchers found no serious adverse events. In total, 20 patients (16.4 percent) experienced 35 minor adverse events, and six (4.9 percent) had multiple adverse events. The incidence of adverse events was lower overall in patients treated with adalimumab compared to those treated with infliximab. Also, more patients treated with infliximab developed multiple adverse events.

Based on the results, the team concluded that “adalimumab has a better efficacy and safety profile in the medium term than infliximab for the treatment of refractory JIA-associated uveitis.”