Background <p>This study aimed to identify the clinical characteristics of cases that is related to the response rate of adalimumab (ADA) treatment.</p> Methods <p>A retrospective review of medical records was conducted for pediatric patients with non-infectious uveitis undergoing ADA treatment for a minimum of six months. The patients were stratified into two groups: those with anterior segment inflammation (ASI+) and those without anterior segment inflammation (ASI-). The primary outcome was treatment success rate. Secondary outcomes including best-corrected visual acuity (BCVA), inflammation parameters [anterior chamber cell (ACC), vitreous haze (VH)], retinal nerve fiber layer (RNFL) thickness, fluorescein angiography (FA) scores, as well as systemic immunosuppression therapy (IMT) and glucocorticoid load, were assessed.</p> Results <p>The study included 59 patients (111 eyes), with 44 patients (83 eyes, 74.58%) falling into the ASI + group and 15 patients (28 eyes, 25.42%) in the ASI- group. The treatment success rate in the ASI + group was significantly higher than in ASI- patients (93.18% vs. 20%, <i>p</i> &lt; 0.001). Following 6-month of ADA treatment in the ASI + group, there was a significant improvement in BCVA (<i>p</i> &lt; 0.001), inflammation parameters (<i>p</i> &lt; 0.001), reduced RNFL thickness and reduced FA scores (<i>p</i> &lt; 0.001). Conversely, no significant differences were observed in BCVA, inflammation parameters, RNFL thickness and FA scores in the ASI- group. There was also a significant decrease in systemic IMT and glucocorticoid dosing, comparing baseline to the 6-month follow-up visit in both the ASI+ (<i>p</i> &lt; 0.001) and ASI- groups (<i>p</i> &lt; 0.05). Adverse events observed during the study period included abdominal pain, skin erythema, articular symptoms and respiratory infections.</p> Conclusion <p>ADA demonstrates superior efficacy in the treating pediatric non-infectious uveitis with ASI + compared to ASI-.</p>