Adalimumab Dose Adjustment for Pediatric Uveitis Treatment Trial (ADAPT)

July 7, 2026 updated by: Nisha Acharya

The goal of this clinical trial is to learn whether children and young adults with well-controlled juvenile idiopathic arthritis (JIA)-associated uveitis or chronic anterior uveitis can safely take adalimumab (or biosimilar) injections less often while maintaining control of their disease.

The main question it aims to answer is: can adalimumab/biosimilar injections be given less frequently without uveitis (eye inflammation) or arthritis (joint inflammation) returning?

Researchers will compare adalimumab/biosimilar injection schedules of every 2 weeks, 4 weeks, 8 weeks, and 12 weeks to determine how injection frequency affects disease control.

Participants will:

  • Take adalimumab/biosimilar injections every 2, 4, 8, or 12 weeks.
  • Attend study visits every 6 weeks over 24 weeks, with an additional follow-up visit at 48 weeks for checkups, tests, and questionnaires.
  • Keep a diary of how often they take adalimumab/biosimilar and other drugs they take for their uveitis/arthritis.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

160

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Italy
      • Florence, Italy, 50139
        • Meyer Children's Hospital
        • Principal Investigator:
          • Gabriele Simonini
        • Contact:
        • Principal Investigator:
          • Ilaria Maccora
  • United Kingdom
      • Bristol, United Kingdom, BS1 3NU
        • University Hospitals Bristol and Weston
        • Principal Investigator:
          • A V Ramanan
        • Contact:
        • Principal Investigator:
          • Catherine Guly
      • Leicester, United Kingdom, LE1 5WW
        • University Hospitals of Leicester
        • Contact:
        • Principal Investigator:
          • Arani Sridhar
        • Principal Investigator:
          • Bharat Kapoor
      • Liverpool, United Kingdom, L14 5AB
        • Alder Hey Children's Hospital
        • Principal Investigator:
          • Gavin Cleary
        • Principal Investigator:
          • Jose Gonzalez-Martin
        • Contact:
      • London, United Kingdom, WC1N 3JH
        • Great Ormond Street Hospital
        • Principal Investigator:
          • Elena Moraitis
        • Principal Investigator:
          • Harry Petrushkin
        • Contact:
        • Sub-Investigator:
          • Lola Solebo
      • Manchester, United Kingdom, M13 9WL
        • Manchester University NHS Foundation Trust
        • Contact:
        • Principal Investigator:
          • Jane Ashworth
      • Newcastle upon Tyne, United Kingdom, NE1 4LP
        • Great North Children's Hospital
        • Principal Investigator:
          • Sharmila Jandial
        • Contact:
      • Norwich, United Kingdom, NR4 6TZ
        • Norfolk and Norwich University Hospital
        • Principal Investigator:
          • Kate Armon
        • Principal Investigator:
          • Narman Puvanachandra
        • Contact:
      • Sheffield, United Kingdom, S10 2TQ
        • Sheffield Children's Hospital
  • United States
    • California
      • Los Angeles, California, United States, 90095
        • University of California, Los Angeles
        • Principal Investigator:
          • Edmund Tsui, MD
        • Contact:
      • Sacramento, California, United States, 95817
        • University of California, Davis
        • Contact:
        • Principal Investigator:
          • Parisa Emami-Naeini, MD MPH
        • Principal Investigator:
          • Angel Herrera-Guerra, MD PhD
      • San Francisco, California, United States, 94143
        • University of California, San Francisco
        • Principal Investigator:
          • Nisha Acharya, MD
        • Contact:
        • Sub-Investigator:
          • John Gonzales, MD
        • Sub-Investigator:
          • Thuy Doan, MD PhD
    • Florida
      • Miami, Florida, United States, 33136
        • University of Miami
        • Contact:
        • Principal Investigator:
          • Stephanie Llop, MD
        • Sub-Investigator:
          • Janet Davis, MD
    • Missouri
      • Kansas City, Missouri, United States, 64108
        • Children's Mercy Hospital
        • Contact:
        • Principal Investigator:
          • Ashley Cooper, MD
        • Principal Investigator:
          • Erin Stahl, MD
    • Ohio
      • Cincinnati, Ohio, United States, 45229
        • Cincinnati Children's Hospital
        • Principal Investigator:
          • Virginia Miraldi Utz, MD
        • Principal Investigator:
          • Sheila Angeles-Han, MD
        • Contact:
    • Tennessee
      • Nashville, Tennessee, United States, 37212
        • Vanderbilt University Medical Center
        • Contact:
        • Principal Investigator:
          • Sapna Gangaputra, MD MPH
        • Principal Investigator:
          • Thomas (Brent) Graham, MD MS
    • Texas
      • Austin, Texas, United States, 78712
        • University of Texas, Austin
        • Contact:
        • Principal Investigator:
          • Eric Crowell, MD MPH
    • Utah
      • Salt Lake City, Utah, United States, 84132
        • University of Utah Health
        • Contact:
        • Principal Investigator:
          • Marissa Larochelle, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Stated willingness to comply with all study procedures and availability for the duration of the study period
  • History of juvenile idiopathic arthritis (JIA) or chronic anterior uveitis (CAU), diagnosed prior to 16 years of age (patient may be older than 16 at time of enrollment)
  • ≥2 years of age (per FDA approval for use in children with polyarticular JIA)
  • Weight must be ≥15kg
  • Formal diagnosis of JIA-associated uveitis or CAU with no other suspected etiology
  • ≥24 consecutive months of controlled ocular inflammation (≤0.5+ anterior chamber cell, ≤0.5+ vitreous haze, and no active retinal/choroidal lesions in either eye)
  • ≥24 consecutive months of controlled arthritis verified by a pediatric rheumatologist if defined as JIA-associated uveitis
  • ≥24 consecutive months of treatment with adalimumab or biosimilar of adalimumab
  • ≥180 days on a stable dose of adalimumab or biosimilar of adalimumab; dose must be no greater than 20mg (if weight <30kg), or 40mg (if weight ≥30kg), injected every two weeks
  • If on biosimilar of adalimumab, ≥90 days on the biosimilar
  • Ability to continue to obtain commercial supply of adalimumab or biosimilar
  • If on a conventional disease-modifying anti-rheumatic drug (cDMARD) (injectable or oral methotrexate, mycophenolate mofetil, azathioprine, or leflunomide), dose must be ≤25 mg weekly for methotrexate, ≤3 g daily for mycophenolate mofetil, ≤250 mg daily for azathioprine, or ≤20 mg daily for leflunomide; dose and route of administration must be stable for ≥90 days
  • Willingness to limit consumption of alcohol during the study period
  • Agreement to avoid live attenuated vaccinations
  • Agreement to use highly effective contraception or abstinence for ≥28 days prior to screening and throughout the study period (for males and females of reproductive age)
  • Suitable, in the opinion of the Investigator, to continue treatment with adalimumab/biosimilar per regional labeling

Exclusion Criteria:

  • History of acute anterior uveitis characterized by redness and symptoms, including but not limited to floaters, pain, and light sensitivity
  • Intraocular surgery in the past 90 days or planned surgery in the next 24 weeks
  • Severe cataract or opacity preventing view to the posterior pole in both eyes
  • Chronic hypotony (<5mmHg for ≥90 days) in either eye
  • Treatment with oral corticosteroids or intraocular corticosteroid injection within the last 24 weeks
  • Use of topical corticosteroid eye drops within the last 90 days
  • Use of nonsteroidal anti-inflammatory drug (NSAID) eye drops within the last 90 days
  • Pregnancy or lactation (a pregnancy test will be conducted at baseline and follow-up visits for females post-menarche)
  • Presence of intraretinal or subretinal fluid in either eye
  • Prior safety or tolerability issues with adalimumab
  • History of cancer, active tuberculosis, or hepatitis B
  • Other medical condition expected to dictate treatment course during the study
  • Any of the following laboratory test results on their most recent tests within the past 90 days prior to screening/enrollment: leukocyte count <2500, platelet count ≤75000, hemoglobin<9.0, aspartate transaminase (AST) or alanine transaminase (ALT) ≥ 2 times the upper limit of normal range, creatinine ≥1.5

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: 2-Week Dose
Participants receive adalimumab/biosimilar at their current weight-based dose every 2 weeks for 24 weeks, continuing in accordance with current standard of care practice.
Biological: Adalimumab/Biosimilar
Adalimumab is a fully human monoclonal anti-tumor necrosis factor alpha antibody - a biologic, immunomodulatory drug. Adalimumab (20mg or 40mg) is a clear, colorless solution available as an injectable auto-pen or pre-filled syringe for subcutaneous injection. All FDA-approved adalimumab biosimilars are allowed for this trial and include: Abrilada (adalimumab-afzb), Amjevita (adalimumab-atto), Cyltezo (adalimumab-adbm), Hadlima (adalimumab-bwwd), Hulio (adalimumab-fkjp), Hyrimoz (adalimumab-adaz), Idacio (adalimumab-aacf), Simlandi (adalimumab-ryvk), Yuflyma (adalimumab-aaty), and Yusimry (adalimumab-aqvh).
Other Names:
  • Humira
  • Hyrimoz
  • Idacio
  • Hulio
  • Simlandi
  • Abrilada
  • Amjevita
  • Cyltezo
  • Hadlima
  • Yuflyma
  • Yusimry
Experimental: 4-Week Dose
Participants receive adalimumab/biosimilar at their current weight-based dose every 4 weeks for 24 weeks.
Biological: Adalimumab/Biosimilar
Adalimumab is a fully human monoclonal anti-tumor necrosis factor alpha antibody - a biologic, immunomodulatory drug. Adalimumab (20mg or 40mg) is a clear, colorless solution available as an injectable auto-pen or pre-filled syringe for subcutaneous injection. All FDA-approved adalimumab biosimilars are allowed for this trial and include: Abrilada (adalimumab-afzb), Amjevita (adalimumab-atto), Cyltezo (adalimumab-adbm), Hadlima (adalimumab-bwwd), Hulio (adalimumab-fkjp), Hyrimoz (adalimumab-adaz), Idacio (adalimumab-aacf), Simlandi (adalimumab-ryvk), Yuflyma (adalimumab-aaty), and Yusimry (adalimumab-aqvh).
Other Names:
  • Humira
  • Hyrimoz
  • Idacio
  • Hulio
  • Simlandi
  • Abrilada
  • Amjevita
  • Cyltezo
  • Hadlima
  • Yuflyma
  • Yusimry
Experimental: 8-Week Dose
Participants receive adalimumab/biosimilar at their current weight-based dose every 8 weeks for 24 weeks.
Biological: Adalimumab/Biosimilar
Adalimumab is a fully human monoclonal anti-tumor necrosis factor alpha antibody - a biologic, immunomodulatory drug. Adalimumab (20mg or 40mg) is a clear, colorless solution available as an injectable auto-pen or pre-filled syringe for subcutaneous injection. All FDA-approved adalimumab biosimilars are allowed for this trial and include: Abrilada (adalimumab-afzb), Amjevita (adalimumab-atto), Cyltezo (adalimumab-adbm), Hadlima (adalimumab-bwwd), Hulio (adalimumab-fkjp), Hyrimoz (adalimumab-adaz), Idacio (adalimumab-aacf), Simlandi (adalimumab-ryvk), Yuflyma (adalimumab-aaty), and Yusimry (adalimumab-aqvh).
Other Names:
  • Humira
  • Hyrimoz
  • Idacio
  • Hulio
  • Simlandi
  • Abrilada
  • Amjevita
  • Cyltezo
  • Hadlima
  • Yuflyma
  • Yusimry
Experimental: 12-Week Dose
Participants receive adalimumab/biosimilar at their current weight-based dose every 12 weeks for 24 weeks.
Biological: Adalimumab/Biosimilar
Adalimumab is a fully human monoclonal anti-tumor necrosis factor alpha antibody - a biologic, immunomodulatory drug. Adalimumab (20mg or 40mg) is a clear, colorless solution available as an injectable auto-pen or pre-filled syringe for subcutaneous injection. All FDA-approved adalimumab biosimilars are allowed for this trial and include: Abrilada (adalimumab-afzb), Amjevita (adalimumab-atto), Cyltezo (adalimumab-adbm), Hadlima (adalimumab-bwwd), Hulio (adalimumab-fkjp), Hyrimoz (adalimumab-adaz), Idacio (adalimumab-aacf), Simlandi (adalimumab-ryvk), Yuflyma (adalimumab-aaty), and Yusimry (adalimumab-aqvh).
Other Names:
  • Humira
  • Hyrimoz
  • Idacio
  • Hulio
  • Simlandi
  • Abrilada
  • Amjevita
  • Cyltezo
  • Hadlima
  • Yuflyma
  • Yusimry

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cumulative Incidence of Treatment Failure
Time Frame: From baseline to 24 weeks post-randomization

Proportion of participants in each treatment arm experiencing treatment failure by Week 24.

Treatment failure is defined by recurrence of ocular inflammation (at least one of the following in at least one eye):

  • >0.5+ anterior chamber (AC) cell at a single visit as defined by the Standardization of Uveitis Nomenclature (SUN) criteria
  • >0.5+ vitreous haze at a single visit
  • Active retinal/choroidal inflammation and/or macular edema in either eye at a single visit. Macular edema is defined as central subfield thickness on optical coherence tomography (OCT) >2 standard deviations above normal thickness (>320µm on Spectralis or >300µm on Zeiss or Topcon) and having a greater than 20% increase from baseline and/or presence of intraretinal or subretinal fluid.

Treatment failure may also be defined as recurrence of joint disease persistent and severe enough to necessitate unmasking to manage the arthritis recurrence.
From baseline to 24 weeks post-randomization

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Nisha Acharya

Collaborators

University of California, Los Angeles
University of Miami
National Eye Institute (NEI)
National Institutes of Health (NIH)
University of California, Davis
University of California, San Francisco
Norfolk and Norwich University Hospitals NHS Foundation Trust
Vanderbilt University Medical Center
Children's Hospital Medical Center, Cincinnati
University of Utah
Moorfields Eye Hospital NHS Foundation Trust
University Hospitals, Leicester
Manchester University NHS Foundation Trust
Children's Mercy Hospital Kansas City
Newcastle-upon-Tyne Hospitals NHS Trust
University Hospitals Bristol and Weston NHS Foundation Trust
University of Texas at Austin
Great Ormond Street Hospital for Children NHS Foundation Trust
Alder Hey Children's NHS Foundation Trust
Sheffield Children's NHS Foundation Trust
Meyer Children's Hospital IRCCS

Investigators

  • Principal Investigator: Nisha Acharya, MD MS, University of California, San Francisco

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

September 1, 2026

Primary Completion (Estimated)

May 1, 2030

Study Completion (Estimated)

November 1, 2030

Study Registration Dates

First Submitted

July 7, 2026

First Submitted That Met QC Criteria

July 7, 2026

First Posted (Actual)

July 13, 2026

Study Record Updates

Last Update Posted (Actual)

July 13, 2026

Last Update Submitted That Met QC Criteria

July 7, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 25-45347
  • UG1EY038172 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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