Anterior uveitis risk in AS two- to fourfold higher with etanercept vs adalimumab, infliximab
Treatment with tumour necrosis factor-α inhibitor (TNFi) may influence the risk of anterior uveitis (AU) in patients with ankylosing spondylitis (AS), according to a Swedish study. Specifically, adalimumab and infliximab have a protective effect, while etanercept contributes to an increased AU risk.
The study included 1,365 AS patients who had initiated treatment with infliximab (n=605), adalimumab (n=406) or etanercept (n=354). The age of the cohort was 43 years on average, and more than 70 percent were male.
Determined by linkage to the Swedish National Patient Register, AU rates 2 years before TNFi initiation (pretreatment) and for the first 2 years of TNFi treatment were compared for each treatment group. The risk of a first AU event was compared within the subgroup of patients who were not diagnosed with AU during the 2 years pre-TNFi treatment.
Cox proportional hazard regression was used in the analyses. Factors such as age, sex, start year for TNFi, disease duration at TNFi initiation, IBD history and baseline CRP, csDMARD comedication, prednisolone and NSAID were included as potential confounders.
Compared with pretreatment rates, AU rates during the first 2 years of TNFi initiation decreased from 19.2 to 7.6 percent in adalimumab group and from 16.9 to 13.1 percent in the infliximab group. In contrast, the rate increased from 16.4 to 22.9 percent in the etanercept group.
Cox analysis of the 1,127 patients who were AU-free in the last 2 years prior to TNFi start found AU risk to be significantly higher after etanercept initiation than after either adalimumab (adjusted hazard ratio [HR], 3.86; 95 percent CI, 1.85 to 8.06) or infliximab initiation (HR, 1.99; 1.23 to 3.22). The risk did not significantly differ between the groups of patients who initiated adalimumab and infliximab.
“In AS, the visual prognosis after acute AU is excellent with adequate treatment, which usually includes topical (and at times oral and locally injected) corticosteroids,” researchers said.
The finding that monoclonal TNF antibodies may protect against AU flares more effectively than the soluble TNF receptor etanercept is consistent with those previously reported in several studies. [Arthritis Rheum 2005;52:2447–51; Ann Rheum Dis 2006;65:1631–4; Semin Arthritis Rheum 2011;41:503–10; Curr Med Res Opin 2014;30:2515–21]
Given the increase in AU risk when starting etanercept vs adalimumab or infliximab, AS patients with a history of AU may fare better with another TNFi than etanercept, researchers said.