Adalimumab had a slight advantage over infliximab in terms of adverse events when used to treat patients with noninfectious uveitis (NIU).
Infliximab and adalimumab were found to have similar therapeutic efficacy and corticosteroid-sparing effect when treating patients with noninfectious uveitis (NIU), according to a review published in BMC Ophthalmology. However, adalimumab was marginally better when assessing the number of adverse events.
NIU is a “heterogeneous collection of intraocular inflammatory diseases of the uveal tract,” with 22% of patients who have uveitis at an increased risk of going blind at the same time. NIU is slightly more common than infectious uveitis. Corticosteroids are effective in eliminating inflammation but are not as effective in treating patients with severe and refractory uveitis.
The efficacy of treating NIU with infliximab and adalimumab has rarely been tested. This systematic review aimed to obtain evidence that evaluated the safety and efficacy of the 2 anti–tumor necrosis factor–α (anti-TNF-α) agents for treating NIU.
A search through PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases was conducted for studies restricted to the English language; the China National Knowledge Infrastructure and Wan Fang databases were used for studies restricted to the Chinese language. The search time frame was from inception to September 15, 2022; grey literature was also searched.
Studies were excluded if there were duplicate reports in the same study, outcomes or baseline information were not clearly stated, data could not be extracted, or the articles were reviews or meta-analyses. Studies were included if they were randomized controlled trials or retrospective studies, they contained infliximab and adalimumab as the same cohort compared with other immunosuppressants, they included at least 1 type of NIU, the mean follow-up time was more than 6 months, and they had at least 10 patients with NIU in each group.
The primary outcomes measuring efficacy were the number of patients with NIU who experienced remission of inflammation and the assessment of corticosteroid-sparing effect. Safety was measured by the incidence of adverse events, which included allergic reactions, reactivated infection, gastrointestinal discomfort, and death related to an adverse event. Data were extracted from all included studies on date of publication, sample size, country of the study, type of NIU, type of anti-TNF-α agents, and number of patients with adverse events, among other extracted information.
There were 11 studies selected for this review, 9 of which came from Europe with the remaining 2 coming from Japan and Turkey. There were 9 retrospective studies and 2 prospective studies, with 1459 total patients (54% female); all studies were from 2011 to 2022. Follow-up time ranged from 0.5 to 3 years, and the mean age reported in each study ranged from 8.8 to 57.6 years.
Complete remission of inflammation was defined as the absence of active uveitis for more than 6 months. The researchers found that there were 161 (37.5%) patients from 5 studies with 429 patients who had complete remission of inflammation after infliximab therapy at 1 year and 151 of 381 (39.6%) who achieved remission when treated with adalimumab. Four studies with a combined pool of 449 patients found that 88.6% of patients treated with infliximab and 86.4% of patients treated with adalimumab had achieved partial or complete remission.
No significant differences were found between infliximab and adalimumab in their corticosteroid-sparing effect and heterogeneity. A total of 16.45% of the 1459 patients reported an adverse event. A random effects model found that there was no statistically significant difference in the incidence of adverse events between the 2 medications (odds ratio, 1.35; 95% CI, 0.79-2.31). A sensitivity analysis found that there were statistically significant differences, with incidence of adverse events totaling 17.91% for infliximab and 12.12% for adalimumab when omitting data from 1 study.
The authors of the review noted that studies that have only 1 year of follow-up are not sufficient to evaluate the efficacy and safety of infliximab and adalimumab. There were also no randomized controlled trials included in the meta-analysis.
The researchers concluded that infliximab and adalimumab are similar in efficacy and in corticosteroid-sparing effect but adalimumab had fewer adverse events reported, giving it a slight advantage in treating NIU.
Liu W, Bai D, Kou L. Comparison of infliximab with adalimumab for the treatment of non-infectious uveitis: a systematic review and meta analysis. BMC Ophthalmol. 2023;23:240. doi:10.1186/s12886-023-02987-1