Comparing the risk of developing uveitis in patients initiating anti-tumor necrosis factor therapy for ankylosing spondylitis: an analysis of a large US claims database

Abstract

The results indicated that initial adalimumab therapy is associated with a significantly lower risk of developing uveitis compared to initial etanercept therapy in patients diagnosed with AS and no prior history of uveitis; however, the risk was not different between adalimumab and infliximab. Limitations to consider when interpreting this conclusion include that disease-level clinical data, such as disease duration, were not available for inclusion in the model and that risk of uveitis beyond 1 year was not evaluated.

Tumour necrosis factor inhibitor treatment and occurrence of anterior uveitis in ankylosing spondylitis: results from the Swedish biologics register

“…However, in this latter meta-analysis, none of the RCTs included was designed to specifically investigate the effect of TNFi on AU, and the numbers of AU events were small, which may explain the discrepant results. The findings of our study are in line with the study based on US claims data,17 although we found an even larger difference between ETN and ADA than the US claims study (HR 3.86 vs 1.91) 17. The biological explanation for the differences in AU rates between monoclonal TNF antibodies and ETN is unclear, and suggested mechanisms include both a differential protective effect and the possibility of a paradoxical AU induction by ETN,17 but it should also be noted that previous studies have indicated that ETN still reduces the number of AU flares more effectively than placebo 12…”

“…Similar trends have been observed previously,17 but it should be stressed that the IFX doses in the current study tended to be lower than the labelled dose in AS, which is 5 mg/kg. The comparative effect of ADA versus IFX should therefore be interpreted with caution.…”

“…That monoclonal TNF antibodies may protect against AU flares more effectively than the soluble TNF receptor ETN, has been reported previously in one meta-analysis,10 two retrospective observational studies of different designs16 18 and one observational study based on a US claims database 17. In addition, data derived from adverse drugs events reporting (not including cases with AS) have supported this finding 24.…”

Etanercept and uveitis: friends or foes?

“…In the current study, Wendling et al limitations to be considered are the lack of data on disease duration, the limited time frame used to evaluate the development of uveitis (only one year), the role of switching TNF agents in some patients before the development of uveitis and the possible influence of cardiovascular risk factors, as recently suggested by Berg et al 8 . In spite of these limitations, Wendling et al 7 confirm the results obtained in previous studies that suggested a differentiated effect of etanercept compared with infliximab/adalimumab for the management of uveitis associated with ankylosing spondylitis.…”

“…Subsequent studies have compared rates of uveitis before and after anti-TNF treatment: while rates were significantly reduced after the use of infliximab (from 47-62 to 3-6 flares per 100 patient-years) 11,12 or adalimumab (from 60-68 to 0-29 flares per 100 patient-years) 11,13 , rates increased after etanercept therapy (from 34-54 to 58-60 flares per 100 patient-years) 11,12 . Wendling et al 7 have shown a lower frequency of a first episode of uveitis in patients with ankylosing spondylitis treated with infliximab/adalimumab. All these studies point in the same direction: that etanercept has lower efficacy than monoclonal anti-TNF, either because it causes more uveitis flares or because it is less effective in preventing new flares.…”