Risk of Acute Anterior Uveitis in Ankylosing Spondylitis According to the Type of Tumor Necrosis Factor-Alpha Inhibitor and History of Uveitis: A Nationwide Population-Based Study.

Soo Min Ahn,Minju Kim,Yong-Gil Kim,Yusun Lee,Ye-Jee Kim

doi:10.3390/jcm11030631

Abstract

Background: We evaluated the risk of acute anterior uveitis (AAU) in patients with ankylosing spondylitis (AS) during treatment with tumor necrosis factor-alpha inhibitors (TNFis). Methods: This study was performed on AS patients using the Korean National Health Insurance claims database. We analyzed the first and total occurrence of AAU during the first 2 years of TNFis use according to the type of TNFis. Additionally, the occurrence of AAU was assessed in subgroups with or without prior AAU before TNFis initiation. Results: In total, 5938 AS patients initiated TNFis use between 2009 and 2017 and used them for more than 2 years. Among them, 1488 (25.1%) patients had a history of AAU before starting TNFis treatment. Compared to adalimumab, the use of etanercept (hazard ratio [HR] 1.77) increased the risk of AAU. The incidence rate ratio (IRR) of AAU with etanercept was significantly higher than that of adalimumab (IRR 1.78). The IRR of AAU was also higher for etanercept than adalimumab use in patients with (IRR 1.86) and without (IRR 2.92) a history of AAU. Conclusion: These data suggest that compared to anti-TNF-alpha monoclonal antibodies, etanercept has a higher incidence of AAU regardless of a history of AAU.

Highlights

Ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly affects the spine, sacroiliac joints, and peripheral joints and it is often accompanied by extraarticular manifestations [1]
Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine that is critical in maintaining host defenses; it plays a key role in the pathogenesis of several chronic inflammatory diseases, including AS [4]
Results from the Swedish biologics register reported that ETN is significantly associated with a higher hazard ratio (HR) of uveitis (3.86) compared to ADA and 1.99 compared to IFX [9]

Summary

Introduction

Ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly affects the spine, sacroiliac joints, and peripheral joints and it is often accompanied by extraarticular manifestations [1]. Acute anterior uveitis (AAU) is the most common extraarticular manifestation in AS, with a pooled prevalence of 25.8% according to a recent metaanalysis [2]. Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine that is critical in maintaining host defenses; it plays a key role in the pathogenesis of several chronic inflammatory diseases, including AS [4]. The introduction of TNF-α inhibitors (TNFis) has led to a significant improvement in the treatment of AS. Several studies have reported the efficacy of TNFis in reducing the incidence rate (IR) of AAU in patients with AS [5,6]

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Methods

Results