Give weekly adalimumab a chance before discontinuing it - a retrospective clinical and pharmacokinetic analysis in pediatric rheumatology

Sep 28, 2026

Uploaded by dhado

Subcutaneous adalimumab is commonly used every other week for children with juvenile idiopathic arthritis (JIA) and non-infectious uveitis, but some patients fail or lose response, prompting escalation to weekly dosing. This retrospective analysis assessed clinical outcomes and pharmacokinetics in pediatric patients with JIA or idiopathic uveitis who did not respond to biweekly treatment. Weekly administration improved disease control and increased predicted drug concentrations, with therapeutic levels exceeding 9.6 mg/L particularly in high-clearance patients. No adverse events were observed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Background

Methods

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Burlo et al. Arthritis Research & Therapy (2025) 27:230 [https://doi.org/10.1186/s13075-025-03688-4](https://doi.org/10.1186/s13075-025-03688-4) Arthritis Research & Therapy RESEARCH Open Access Give weekly adalimumab a chance before discontinuing it: a retrospective clinical and pharmacokinetic analysis in pediatric rheumatology Francesca Burlo 1, Serena Pastore2*, Gabriele Stocco 1,2, Paolo Dalla Zuanna2, Debora Curci2, Tomoyuki Mizuno3,4, Kei Irie3, Andrea Taddio 1,2 and Alberto Tommasini 1,2 Abstract Background Subcutaneous adalimumab is the preferred treatment for most children with juvenile idiopathic arthritis (JIA) and non-infectious uveitis, usually administered every other week. Some patients do not respond or lose responsiveness over time, leading to dose escalation to weekly administration. This study evaluated the efficacy and pharmacokinetics of weekly subcutaneous adalimumab in children with JIA and idiopathic uveitis. Methods This is a retrospective study on clinical and pharmacokinetic characteristics of patients treated with subcutaneous adal imumab for psoriatic arthritis or non-infectious uveitis (idiopathic or JIA-associated) who did not respond or ceased to respond to biweekly administration. Results Four patients were enrolled: three females and one male, with a median age of 15 years (range 7–18; IQR 6) . One had juvenile psoriatic arthritis, two had idiopathic uveitis, and one had JIA-related uveitis. They all presented a poor control of the disease on biweekly administrations, while it was successfully controlled on weekly administrations. None of them presented adverse events. Pharmacokinetic analyses identified two groups of patients: those with high clearance and those with low clearance. In both groups, weekly dosing increased the predicted drug concentrations, and in patients with high clearance only weekly administration provided the predicted concentration exceeding the therapeutic cut-off of 9.6 mg/L. Conclusions Weekly adal imumab administrations were safe and effective in controlling both articular and ocular inflammation. In cases where the disease is poorly controlled with regular biweekly administrations, we encourage escalating adal imumab treatment to weekly administration before adding other therapies or switching to different biologics. Keywords Adal imumab, Uveitis, Inflammation, Children, Pharmacokinetics *Correspondence: Serena Pastore [serena.pastore@burlo.trieste.it](serena.pastore@burlo.trieste.it) 1Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy 2Institute for Maternal and Child Health“IRCCS Burlo Garofolo”, Via dell’Istria 65, Trieste 34137, Italy 3Division of Translational and Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA 4Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)

FAQs

Why was weekly adalimumab considered instead of continuing biweekly dosing?

Some pediatric patients with JIA and non-infectious uveitis do not respond or lose responsiveness over time on biweekly administration, leading to dose escalation to weekly dosing.

What did the study find about efficacy and disease control?

All enrolled patients had poor control on biweekly administrations, while disease control was successful on weekly administrations.

How did pharmacokinetic results support weekly dosing, and were safety issues reported?

Pharmacokinetic analyses identified high- and low-clearance groups; in both, weekly dosing increased predicted concentrations, and in high-clearance patients only weekly administration exceeded the therapeutic cut-off of 9.6 mg/L. None of the patients presented adverse events.

Sep 28, 2026

Uploaded by dhado