Etanercept does not increase incident uveitis in juvenile idiopathic arthritis
Among children with juvenile idiopathic arthritis (JIA), the risk of developing uveitis is not greater in those treated with etanercept (ETN) than in those receiving methotrexate (MTX), according to a study presented at the European League Against Rheumatism (EULAR) 2018 Congress.
“This is reassuring given the reports of possible increased risk of uveitis among children with JIA receiving ETN,” the investigators said.
The study included 1,517 patients recruited to the BSPAR ETN* cohort study, among whom 1,009 (median age 11 years; 69 percent female) were on ETN and 508 (median age 9 years; 71 percent female) on MTX. Aside from being older, ETN-treated patients had longer disease duration (median, 3 vs 1 year) and were less likely to have persistent oligoarthritis (5 percent vs 17 percent).
New-onset uveitis occurred in 15 patients in the ETN cohort and 18 in the MTX cohort at a mean age of 8 and 5 years, respectively. The corresponding crude incidence rates were 0.6 and 2.4 per 100 person-years. [EULAR 2018, abstract OP0351]
Propensity-adjusted Cox regression showed that ETN reduced the risk of developing uveitis by 70 percent compared with MTX (hazard ratio, 0.30; 95 percent CI, 0.10–0.90). Factors such as age and gender, disease scores, disease duration, baseline steroid use, comorbidity, and International League of Associations for Rheumatology subtype were included in the analysis as potential confounders.
“Age appears to be a major influencing factor as patients in the MTX cohort were younger [and] thus at a higher risk of uveitis. For patients with a higher uveitis risk, other treatments options could have been selected, leading to possible confounding by indication, which in turn makes ETN look protective,” the investigators pointed out. “Researchers should take these selection biases into account when analysing their results.”
The present data suggest that a new diagnosis of uveitis is not more common among children with JIA receiving ETN vs MTX, despite taking into account differences in age and disease duration between the cohorts, the investigators said.
*British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study