Recurrence Risk in Pediatric Noninfectious Uveitis During Adalimumab Tapering: An International Multicenter Retrospective Study

Objective: This study aims to assess the risk of noninfectious uveitis (NIU) relapse in pediatric patients undergoing adalimumab (ADA) tapering, evaluating potential predictors of such risk. Methods: We conducted a multicenter retrospective cohort study involving pediatric patients with NIU who underwent ADA tapering due to inactive uveitis. Cox proportional hazards regression was used to analyze risk factors for NIU recurrence. Results: The study cohort comprised 114 patients (65 girls; 57%). Most commonly, patients presented with juvenile idiopathic arthritis-associated uveitis (JIA-U) (52 of 114; 46%) or idiopathic uveitis (46 of 114; 40%). At ADA tapering, 46% of patients (53 of 114) experienced NIU recurrence after an overall median time of 30 weeks (interquartile range [IQR] 15-58 weeks) from the start of ADA tapering. Patients without recurrences were observed for a median of 70 weeks (IQR 48-98 weeks). Multivariate Cox regression analysis showed that a slower ADA tapering schedule was associated with a lower recurrence rate during the waning (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.21-0.74; P < 0.01). Subgroup analysis of patients with JIA-U indicated that beginning ADA tapering after at least two years of disease inactivity significantly reduced recurrence risk (HR 0.65, 95% CI 0.43-0.95; P = 0.05). Among 59 patients (52%) who discontinued ADA, recurrence rates were similar between fast- and slow-tapering groups (21% vs 33%; P = 0.6), but median time to recurrence was shorter with fast tapering (10 weeks vs 37 weeks; P = 0.05). Conclusion: This study highlights the significant clinical impact of ADA tapering on uveitis recurrence risk, recommending a gradual, slow-tapering approach with close monitoring.