Abstract
BackgroundThe objective of this study was to compare in real life the occurrence of anterior uveitis in patients with spondyloarthritis (SpA), including psoriatic arthritis (PsA), treated with the soluble-receptor etanercept (ETA) or monoclonal antibodies (mAbs).MethodsThis was an observational, retrolective study. Patients with SpA who were prescribed anti-TNF agents between 2000 and 2014 were included. The risk of uveitis was interpreted qualitatively (number of subjects with at least one uveitis) and quantitatively (number of uveitis flares for each individual). Models were adjusted for propensity score of receiving preferentially mAbs or ETA.ResultsFour hundred twenty-nine patients were included (302 with SpA and 127 with PsA); 203 received a mAb and 226 ETA as a first TNF-α inhibitor. Probability of uveitis occurring during the first year of treatment was lower with ETA than with mAbs but not significantly (odds ratio 0.94 [95% confidence interval 0.35; 2.54], p = 0.90, on qualitative analysis and relative risk 0.62 [0.26; 1.46], p = 0.27, on quantitative analysis) after adjustment for the propensity score. The over-time risk of uveitis was numerically higher with ETA than with mAbs, but the differences were not statistically significant.ConclusionIn this observational study, the risk of uveitis in patients with SpA does not appear to be greater with ETA than with mAb treatment. The occurrence of uveitis in patients receiving an anti-TNF-α agent seems linked more to the history of uveitis than the prescribed molecule.
Highlights
The objective of this study was to compare in real life the occurrence of anterior uveitis in patients with spondyloarthritis (SpA), including psoriatic arthritis (PsA), treated with the soluble-receptor etanercept (ETA) or monoclonal antibodies
Data were collected on the date of diagnosis, comorbidities, general treatments and conventional synthetic disease-modifying anti-rheumatic drugs potentially associated with TNF-α inhibitors (TNFi), the TNFi treatment used and the time elapsed since its introduction, and the uveitis episodes that occurred during pre-treatment and during treatment periods, especially during the first year
The magnitude of the increased risk with ETA was similar to that found in the Swedish Rheumatology Quality Register; the risk of uveitis at 2 years was increased by 1.99-fold with ETA versus infliximab [11]
Summary
The objective of this study was to compare in real life the occurrence of anterior uveitis in patients with spondyloarthritis (SpA), including psoriatic arthritis (PsA), treated with the soluble-receptor etanercept (ETA) or monoclonal antibodies (mAbs). The incidence of acute anterior uveitis in patients with ankylosing spondylitis was found significantly reduced with infliximab or etanercept (ETA) as compared with placebo [1]. A review of 8 randomized trials showed a decrease in the incidence of uveitis in patients receiving ETA versus placebo [7]. Data provided by the randomized study RAPID-AxSpa, evaluating uveitis in both ankylosing spondylitis (AS) and non-radiographic axial SpA, showed a marked decrease in the incidence of acute anterior uveitis with certolizumab versus placebo [10]
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