The Humira in Ocular Inflammations Taper (HOT) Study

center dot PURPOSE: To assess factors that impact the risk of re-lapse in patients with noninfectious uveitis (NIU) who undergo adalimumab tapering after achieving remission.center dot DESIGN: Retrospective study.center dot METHODS: In this multicenter study, patients with NIU were treated with adalimumab and subsequently tapered. Patient demographics, type of NIU, onset and du-ration of disease, the period of inactivity before tapering adalimumab, and the tapering schedule were collected. The primary outcome measures were independent predictors of the rate of uveitis recurrence after adalimumab tapering.center dot RESULTS: Three hundred twenty-eight 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. Adali-mumab 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 = .0005), and the rate of recurrence was significantly higher in younger subjects (hazard ratio [HR] = 0.88 per decade of increasing age, P = .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 < .0005). Conversely, a more extended period of re-mission before tapering was associated with a lower rate of recurrence (HR = 0.97 per 10-weeks longer period of inactivity, P = .04).center dot CONCLUSIONS: When tapering adalimumab, factors that should be considered include patient age, race, and duration of disease remission on adalimumab. A slow tapering schedule is advisable. (Am J Ophthalmol 2024;258: 87-98. (c) 2023 Elsevier Inc. All rights re-served.)