2026-05-30 | Clinical outcomes of weekly adalimumab in refractory non-infectious paediatric uveitis and the role of serum drug levels and anti-adalimumab antibodies.
Adalimumab (ADA) is a well-established treatment for refractory paediatric uveitis; however, some patients remain inadequately controlled on standard biweekly dosing. Weekly ADA injections are increasingly used, though evidence in paediatric cohorts remains limited. This study evaluates outcomes of escalation to weekly ADA in children with refractory uveitis and explores the relevance of serum drug levels and anti-ADA antibodies (AAA). Patients with idiopathic uveitis at two tertiary centres in the UK treated with weekly adalimumab were retrospectively reviewed. Demographic, clinical and laboratory data were collected, including age at escalation, systemic diagnosis, serum ADA levels, AAA titres pre- and post-escalation, clinical response and complications. Treatment success was defined as ≤0.5+ anterior chamber cells and <2 drops/day of steroid eye drops at 3 months, or most recent follow-up where escalation occurred within 3 months of review. 15 patients were included. Mean age at escalation was 11 years (range: 3-17). 11 (73%) had a systemic diagnosis; most commonly juvenile idiopathic arthritis (60%). Median serum level pre-escalation was 10.1 mg/L (IQR: 7.8-11.9) and 18.1 mg/L (IQR: 14.8-22.1) post escalation. AAAs were detectable in 7/15 (47%) pre-escalation, 2/15 (13.3%) post-escalation. Success occurred in 10/15 (67%), with visual acuity stable and improved in 93%. No serious systemic adverse events were reported. Weekly ADA offers a safe and effective treatment alternative for children with refractory uveitis, including those with AAAs. These findings support its inclusion in future treatment pathways, though the predictive value of serum levels and AAAs remains uncertain and warrants further investigation.
Open article ↗
2026-05-23 | Epidemiology and outcomes of non-infectious paediatric uveitis in the French Caribbean: a 15-year cohort study from a high-income health system in Martinique.
Non-infectious uveitis (NIU) are rare in children but might be associated with substantial visual impairment. Most NIU paediatric cohorts originate from Europe, North America, or Asia, with minimal representation of Caribbean populations. Our study aimed to describe the epidemiology, clinical features, aetiologies and outcomes of paediatric NIU in Martinique. We conducted a monocentre, retrospective cohort study that included all children under the age of 18 diagnosed with NIU at the University Hospital of Martinique between 2010 and 2024. We identified cases through paediatric and ophthalmology registries, medical records, and national hospital databases. We excluded infectious uveitis and non-residents. Incidence estimates used population data. A total of 17 children with NIU were included in the study. 41% were male, with a mean age at diagnosis of 8.7 years (range: 2.5-16) and a median follow-up period of 7.6 years (range: 2.2-11.6). Eleven patients had anterior uveitis (64.7%), and 35.3% had panuveitis. Uveitis was unilateral in 64.7% of patients. The estimated incidence was 1.4 per 100,000 person-years (95% CI 0.83-2.27). The leading aetiology was juvenile idiopathic arthritis, accounting for 58.8% of cases. Systemic biologics were used in 17.6% of patients. Only one child experienced visual loss and required ocular surgery at the final follow-up. The first Caribbean paediatric NIU cohort shows a similar etiological spectrum and good visual outcomes as reported in high-income countries.
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2026-05-04 | Model-Based Design of Sustained-Release Formulations of Anti-TNF-α Monoclonal Antibodies for Intravitreal Administration.
Background/Objectives: While intravitreal administration allows for increased ocular exposure to anti-TNF-α monoclonal antibodies, there is still a need for developing delivery systems able to prolong ocular drug exposure and alleviate patient compliance and safety concerns because of repeated injections. Therefore, the objective of this work was to guide the design of sustained-release formulations of anti-TNF-α monoclonal antibodies for intravitreal administration through a model-based strategy in non-infectious uveitis in the preclinical setting. Methods: Using an in-house-developed anterior uveitis disease model in rats, an intravenous reference dose reducing free TNF-α by 90% at the biophase was established. Intravitreal administrations of sustained-release formulations every 24 weeks were then simulated for adalimumab, golimumab and infliximab to evaluate TNF-α kinetics in the anterior chamber of the eye at different release rates. The selected sustained-release formulation was further evaluated for possible formulation issues causing device emptying before the next administration. Results: Intravitreal administration of sustained-release formulations releasing adalimumab, golimumab or infliximab at 1.802, 0.979 and 1.442 μg/week, respectively, met the predefined criteria of ≥90% reduction in free TNF-α at the biophase. TNF-α levels in aqueous humour were anticipated to be the most sensitive to detect possible formulation issues. Formulation emptying 10, 4 or 8 weeks for adalimumab, golimumab and infliximab, respectively, before next administration triggered TNF-α reaching pathological levels at week 24 post-dose. Conclusions: This work underscores the potential of new approach methodologies in the preclinical drug development of sustained-release formulations for intravitreal administration in ocular inflammatory disorders with less animal testing and without compromising the accuracy of model-informed predictions for human translation.
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