Abstract
BackgroundAnterior uveitis (AU) is the most frequent extra-articular feature of axial spondyloarthritis (axSpA). We aimed to assess and compare the incidence of AU in axSpA patients treated with anti-TNF or anti-IL17A.MethodsWe systematically reviewed PubMed, EMBase, and Cochrane from inception to May 3, 2020, and searched for placebo-controlled and head-to-head randomized controlled trials (RCTs) assessing anti-TNF monoclonal antibodies (mAb) or soluble receptor fusion protein or anti-IL17A in patients with axSpA according to ASAS criteria and reporting safety data on AU. Data were extracted following a predefined protocol. We did pairwise and network meta-analyses for the primary outcome of AU flares (relapse or de novo) incidence and estimated summary odds ratios (ORs). We assessed the quality of evidence using the Cochrane risk-of-bias 2.0 tool. We ranked treatments according to their effectiveness in preventing AU flare using the P-score.ResultsWe identified 752 citations and included 33 RCTs, comprising 4544 treated patients (anti-TNF mAb 2101, etanercept [ETN] 699, anti-IL17A 1744) and 2497 placebo-receiving patients. Incidence of uveitis was lower with anti-TNF mAb versus placebo (OR = 0.46; CI 95% [0.24; 0.90]) and versus anti-IL17A (OR = 0.34; CI 95% [0.12; 0.92]. According to the P-score, the ranking from the most to the least preventive treatment of uveitis flare was as follows: anti-TNF mAb, ETN, placebo, and anti-IL17A.ConclusionIn RCTs assessing anti-TNF and anti-IL17A in axSpA, incident uveitis are rare events. However, this network meta-analysis demonstrates that anti-TNF mAb are associated with a lower incidence of uveitis compared to placebo and anti-IL17A.
Highlights
Anterior uveitis (AU) is the most frequent extra-articular feature of axial spondyloarthritis
Several observational studies and post-hoc analysis from placebo-controlled studies focused on axial spondyloarthritis (axSpA)-associated AAU and showed that the incidence of AAU decreases after treatment with anti-TNF monoclonal antibodies (mAb) compared to the incidence before treatment [7,8,9,10,11,12,13]
Anti-TNF mAb were assessed in 17 randomized controlled trials (RCTs) (ADA: 4 [23,24,25,26]; CTZ: 2 [27, 28]; GOL: 4 [29,30,31,32]; IFX: 7 [33,34,35,36,37,38,39]), ETN was assessed in 10 RCTs [39,40,41,42,43,44,45,46,47,48] and anti-IL17A were assessed in 8 RCTs
Summary
Anterior uveitis (AU) is the most frequent extra-articular feature of axial spondyloarthritis (axSpA). Among anti-TNF mAb, ADA has been shown to significantly reduce the risk of non-infectious uveitic flare, associated or not with axSpA, in two placebo-controlled RCTs [5, 6]. Several observational studies and post-hoc analysis from placebo-controlled studies focused on axSpA-associated AAU and showed that the incidence of AAU decreases after treatment with anti-TNF mAb compared to the incidence before treatment [7,8,9,10,11,12,13]. These studies mainly involved IFX and ADA. A meta-analysis of 8 RCTs concluded that anti-TNF mAb were not associated with fewer AAU flares, including relapses and new onset, than placebo [14]
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