Post by Panayiotis Maghsoudlou

Proud to share our editorial, just published in Eye 🔬 ‘The ADJUST trial and its implications for biologic discontinuation in juvenile idiopathic arthritis-associated uveitis’ It was wonderful to meet co-author Prof Nisha Acharya in person this week as she visited with her UCSF team, a timely opportunity to reflect on this work and look ahead to future collaboration. Written with Nisha and Prof Athimalaipet Ramanan FMedSci, this editorial accompanies the landmark ADJUST RCT, published in the Lancet (https://lnkd.in/emDu-gDm) and the first randomised trial to rigorously test whether adalimumab can safely be stopped in children with controlled JIA-associated uveitis. The short answer? Not yet, for most patients. 68% relapsed within 48 weeks of stopping, far exceeding the 30-50% seen in withdrawal trials across other immune-mediated inflammatory diseases. We use the editorial to ask four questions the trial raises: 🔹 When should we stop? Duration of remission did not protect against relapse, even in patients quiescent for over two years. Until validated biomarkers exist, withdrawal decisions must be individualised and followed up intensively 🔹 Why is uveitis different? The eye harbours tissue-resident immune memory that persists despite clinical silence, and our outcome measures are sensitive enough to detect even subtle reactivation 🔹 Can we switch disease off? A window of opportunity, well-established in rheumatoid arthritis, remains unproven in uveitis. 🔹 Should anti-TNF be first-line? With biosimilar adalimumab now widely available, the case for waiting is weakening. The conversation may soon shift from ‘when do we escalate?’ to ‘why wait at all?’ The future may lie in biomarker-guided decisions and lots of work ongoing to uncover these. Until then, the message from ADJUST is clear: proceed with caution before withdrawing. 📄 Eye (2026) 40:288-289 | https://lnkd.in/eFAhD63Q #Uveitis #JIA #Ophthalmology #Rheumatology #ClinicalTrials #PaediatricUveitis #ADJUST