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Reply To the Editor:We would like to express our sincere appreciation to Wang et al for their thoughtful letter regarding our recently published study, “Recurrence Risk in Pediatric Noninfectious Uveitis During Adalimumab Tapering: An International Multicenter Retrospective Study.”1 We are grateful for their interest in our work and for the opportunity to address the important points they have raised.Regarding the first concern, we fully acknowledge the clinical relevance of incorporating both arthritis disease activity and visual acuity outcomes in studies involving juvenile idiopathic arthritis–associated uveitis. However, due to the retrospective nature of our multicenter cohort study, consistent documentation of arthritis activity indices and standardized visual acuity measurements across participating centers was not available. In light of these limitations, we chose to focus on uveitis recurrence, which could be reliably assessed through well‐established ophthalmologic criteria. Nevertheless, we agree that a more holistic evaluation, including systemic and visual outcomes, would provide additional insight into the broader impact of tapering biologic therapy and should be considered in future prospective investigations.The second point raises an important methodologic consideration regarding the quantification of tapering speed. Our classification of “fast” versus “slow” tapering was derived from predefined clinical tapering schedules and supported by a receiver operating characteristic curve analysis using the Youden index to determine the optimal cutoff. Although a continuous model describing the magnitude of dose reduction over time might yield additional granularity, such an approach was not feasible in our data set, given the variability in tapering practices across institutions and the retrospective data collection. We believe that our categorical framework, although pragmatic, reflects the diversity of real‐world clinical decision‐making and offers actionable guidance for clinicians managing these complex cases.Lastly, we concur that longer‐term follow‐up is essential to fully understand the prognostic implications of adalimumab tapering in pediatric uveitis. Although our study focused primarily on the risk of early recurrence, which typically occurs within the first several months after taper initiation, we recognize that extended follow‐up is needed to evaluate sustained remission, treatment‐free intervals, and late‐onset complications. A subset of patients in our cohort did achieve longer‐term follow‐up, and we are currently working toward a future analysis that will address these important outcomes in greater depth.We are thankful to Wang et al for their constructive critique, which highlights the complexities of tapering immunomodulatory therapy in pediatric uveitis and underscores the need for continued collaborative efforts to optimize long‐term outcomes in this population.ReferenceMarino A, Cicinelli MV, Miserocchi E, et al. Recurrence risk in pediatric noninfectious uveitis during adalimumab tapering: an international multicenter retrospective study. Arthritis Rheumatol Published online April 2, 2025. doi:https://doi.org/10.1002/art.43165 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Arthritis & Rheumatology Wiley

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Publisher
Wiley
Copyright
© 2025 American College of Rheumatology.
ISSN
2326-5191
eISSN
2326-5205
DOI
10.1002/art.43267
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Abstract

To the Editor:We would like to express our sincere appreciation to Wang et al for their thoughtful letter regarding our recently published study, “Recurrence Risk in Pediatric Noninfectious Uveitis During Adalimumab Tapering: An International Multicenter Retrospective Study.”1 We are grateful for their interest in our work and for the opportunity to address the important points they have raised.Regarding the first concern, we fully acknowledge the clinical relevance of incorporating both arthritis disease activity and visual acuity outcomes in studies involving juvenile idiopathic arthritis–associated uveitis. However, due to the retrospective nature of our multicenter cohort study, consistent documentation of arthritis activity indices and standardized visual acuity measurements across participating centers was not available. In light of these limitations, we chose to focus on uveitis recurrence, which could be reliably assessed through well‐established ophthalmologic criteria. Nevertheless, we agree that a more holistic evaluation, including systemic and visual outcomes, would provide additional insight into the broader impact of tapering biologic therapy and should be considered in future prospective investigations.The second point raises an important methodologic consideration regarding the quantification of tapering speed. Our classification of “fast” versus “slow” tapering was derived from predefined clinical tapering schedules and supported by a receiver operating characteristic curve analysis using the Youden index to determine the optimal cutoff. Although a continuous model describing the magnitude of dose reduction over time might yield additional granularity, such an approach was not feasible in our data set, given the variability in tapering practices across institutions and the retrospective data collection. We believe that our categorical framework, although pragmatic, reflects the diversity of real‐world clinical decision‐making and offers actionable guidance for clinicians managing these complex cases.Lastly, we concur that longer‐term follow‐up is essential to fully understand the prognostic implications of adalimumab tapering in pediatric uveitis. Although our study focused primarily on the risk of early recurrence, which typically occurs within the first several months after taper initiation, we recognize that extended follow‐up is needed to evaluate sustained remission, treatment‐free intervals, and late‐onset complications. A subset of patients in our cohort did achieve longer‐term follow‐up, and we are currently working toward a future analysis that will address these important outcomes in greater depth.We are thankful to Wang et al for their constructive critique, which highlights the complexities of tapering immunomodulatory therapy in pediatric uveitis and underscores the need for continued collaborative efforts to optimize long‐term outcomes in this population.ReferenceMarino A, Cicinelli MV, Miserocchi E, et al. Recurrence risk in pediatric noninfectious uveitis during adalimumab tapering: an international multicenter retrospective study. Arthritis Rheumatol Published online April 2, 2025. doi:https://doi.org/10.1002/art.43165

Journal

Arthritis & Rheumatology – Wiley

Published: Jun 9, 2025

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