Chronic non-infectious uveitis in children carries a substantial risk of vision loss due to various complications, including cataracts, glaucoma, band keratopathy, and epiretinal membrane. The management of this condition typically involves local and oral corticosteroids, which are associated with well-documented side effects, sometimes in combination with methotrexate as the first-line steroid-sparing agent. When these therapies prove ineffective or result in toxicity, biologic agents are required. The efficacy of anti-TNF alpha therapy in this context has been established in uveitis associated with juvenile idiopathic arthritis (JIA) by two randomized controlled trials [1], [2] and the visual prognosis of these patients has significantly improved since the introduction of anti-TNF alpha agents into the therapeutic regimen [3], [4], [5].

Adalimumab is administered subcutaneously every other week (Q2) at doses of 20 mg or 40 mg, depending on the child's weight. It is now well-established and proven in other specialties, for example in pediatric gastroenterology with the treatment of Crohn's disease [6], [7], or in pediatric rheumatology with the treatment of rheumatologic manifestations of JIA [8] that weekly adalimumab (Q1) is both effective and safe. Moreover, adalimumab Q1 week has been also used in adults in case of recalcitrant ocular inflammation [9] and other indications like Crohn's disease [10], [11], psoriasis [12] or spondylarthritis [13], [14]. This approach is therefore more and more applied in ophthalmo-pediatrics, and observational studies have shown some efficacy and safety of adalimumab Q1 week in chronic refractory pediatric uveitis [8], [15]. In some cases where the efficacy of adalimumab Q2 weeks is suboptimal even in conjunction with methotrexate, it is possible to escalate the treatment to weekly administration after a multidisciplinary consensus and expert opinion, as described in the protocol of The childhood arthritis and rheumatology research alliance consensus treatment plan for uveitis [16].

The aim of this study was to assess the efficacy and safety of adalimumab Q1 week after the failure of adalimumab Q2 weeks administration in children with non-infectious chronic uveitis.