Adalimumab and dexamethasone for treating non-infectious uveitis

Description of the technologies

Adalimumab (Humira, AbbVie) is a monoclonal antibody that reduces inflammation by inhibiting pro-inflammatory cytokine tumour necrosis factor-alpha.

Dexamethasone intravitreal implant (Ozurdex, Allergan) is a biodegradable corticosteroid implant that suppresses inflammation by inhibiting the expression of pro-inflammatory mediators.

Marketing authorisations

Adalimumab is indicated 'for the treatment of non-infectious intermediate, posterior and panuveitis in adult patients who have had an inadequate response to corticosteroids, in patients in need of corticosteroid sparing, or in whom corticosteroid treatment is inappropriate.'

Dexamethasone intravitreal implant is indicated 'for the treatment of adult patients with inflammation of the posterior segment of the eye presenting as non-infectious uveitis.'

Adverse reactions

The most commonly reported adverse reactions with adalimumab are infections (such as nasopharyngitis, upper respiratory tract infection and sinusitis), injection site reactions (erythema, itching, haemorrhage, pain or swelling), headache and musculoskeletal pain.

The most commonly reported adverse events after treatment with dexamethasone intravitreal implant are those often seen with ophthalmic steroid treatment or intravitreal injections (elevated intraocular pressure, cataract formation and conjunctival, or vitreal haemorrhage respectively).

For full details of adverse reactions and contraindications for adalimumab and dexamethasone, see the summaries of product characteristics.

Recommended doses and schedules

The recommended dose of adalimumab for adults with non-infectious uveitis is an initial dose of 80 mg, followed by 40 mg every other week starting 1 week after the initial dose. Adalimumab is given by subcutaneous injection. There is limited experience in starting treatment with adalimumab alone. Treatment with adalimumab can be started in combination with corticosteroids or with other non-biologic immunomodulatory agents. Concomitant corticosteroids may be tapered off according to clinical practice from 2 weeks after starting treatment.

The recommended dose of dexamethasone intravitreal implant is 1 implant, containing 700 micrograms of dexamethasone, to be administered intravitreally to the affected eye. Administration to both eyes concurrently is not recommended. Repeat doses should be considered when a patient experiences a response to treatment followed subsequently by a loss in visual acuity and in the clinician's opinion may benefit from retreatment without being exposed to significant risk.

Prices

Adalimumab costs £704.28 for 2 pre-filled injections and each dexamethasone intravitreal implant costs £870.00 (excluding VAT; 'British National Formulary' [BNF] edition 72). Costs may vary in different settings because of negotiated procurement discounts.