The Humira in Ocular Inflammations Taper (HOT) Study

Purpose To assess factors that impact the risk of relapse in patients with non-infectious uveitis (NIU) who undergo adalimumab tapering after achieving remission. Design Retrospective study. Methods − Setting: Multicenter study. − Study Population: Patients with NIU treated with adalimumab and subsequently tapered. − Observation Procedure: Patient demographics, type of NIU, onset and duration of disease, period of inactivity before tapering adalimumab and tapering schedule were collected. − Main Outcome Measures: Independent predictors of the rate of uveitis recurrence after adalimumab tapering. Results 328 patients were included (54.6% female) with a mean age of 34.3 years. The mean time between disease onset and initiation of adalimumab therapy was 35.2±70.1 weeks. Adalimumab tapering was commenced after a mean of 100.8±69.7 weeks of inactivity. Recurrence was observed in 39.6% of patients at a mean of 44.7±61.7 weeks. Patients who experienced recurrence were significantly younger than those without recurrence (mean 29.4 years vs. 37.5 years, p=0.0005) and the rate of recurrence was significantly higher in younger subjects (HR=0.88 per decade of increasing age, p=0.01). The lowest rate of recurrence was among Asian subjects. A faster adalimumab taper was associated with an increased recurrence rate (HR=1.23 per unit increase in speed, p<0.0005). Conversely, a more extended period of remission prior to tapering was associated with a lower rate of recurrence (HR=0.97 per 10-weeks longer period of inactivity, p=0.04). Conclusions When tapering adalimumab, factors that should be considered include patient's age, race, and duration of disease remission on adalimumab. A slow tapering schedule is advisable.