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Factors Associated with Adalimumab Initiation in Non-Infectious Uveitis: A Propensity Score Matched Analysis
Rupesh Agrawal
Presenter:
Rupesh Agrawal, Cylvin Sim, William Rojas Caraballi, Thng Zheng Xian, SuLing Ho, Bernard Thong and PROTON study group team
Authors:
Affiliation:
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
PROTON study group, Singapore
Objective: To identify factors associated with adalimumab initiation in non-infectious uveitis.
Design: Retrospective case-control study using multicenter data from 3204 patients.
Main Outcome Measures: The primary outcome was whether adalimumab was initiated, and the secondary outcome was time to initiation.
Methods and Controls: To investigate factors influencing the primary outcome, propensity score matching (1:3) was performed to match adalimumab recipients (n=53, cases) to non-recipients (n=159, controls) to reduce confounding by age, sex, race, anatomical category of disease, and follow-up time. Subsequently, subgroup analysis was performed among adalimumab recipients to investigate factors influencing time to initiation. Statistical methods included logistic regression and survival analysis of time to adalimumab initiation. Models were adjusted for potential confounders.
Results: Factors that predicted adalimumab initiation included juvenile idiopathic arthritis (JIA) (multivariable OR=5.90, CI: 1.15-29.91), psoriasis (multivariable OR=24.79, CI: 1.91-620.72), Behcet’s disease (univariable OR=4.74, CI: 1.33-16.68), and retinal vasculitis (univariable OR=2.10; CI: 1.06-4.09). Patients presenting with bilateral disease were initiated on adalimumab earlier (adjusted HR=2.07; CI: 1.08-3.98).
Posterior uveitis was associated with early adalimumab initiation less than one year after uveitis onset (adjusted univariable OR=9.44; CI: 1.01-88.18), while keratic precipitates were associated with late adalimumab initiation one year or more after uveitis onset (adjusted univariable OR=0.18, CI: 0.03-0.93).
Conclusions: Patients presenting with JIA, psoriasis, Behcet’s disease, or retinal vasculitis were more likely to be initiated on adalimumab, and patients with bilateral, posterior disease or without keratic precipitates were initiated earlier. Clinicians may wish to anticipate early escalation to adalimumab in these phenotypes.