Scleritis: A Paradoxical Effect of Etanercept? Etanercept-associated Inflammatory Eye Disease

Abstract

Ocular inflammation is paradoxically a potential adverse effect of etanercept, even in previously uninvolved eyes.

Biological agents in the treatment of uveitis

“…However, the authors commented that their findings do not support the use of infliximab over etanercept but, rather, if a patient develops uveitis during etanercept therapy, then a change to infliximab may be warranted [49]. In a very recent study, it has been observed from data reported in the literature that forty-two cases of inflammatory eye diseases believed to be associated with the use of etanercept include 33 cases of uveitis, 8 scleritis, 1 orbital myositis [50]. These data have been obtained from 16 patients with RA, 10 with JIA, 14 with AS, and 2 with psoriatic spondyloarthropathy.…”

Uveitis in adults: What do rheumatologists need to know?

“…The decrease was statistically significant with monoclonal antibodies (relative risk [RR], 7.4) but not with etanercept (RR, 0.9). Several studies suggest a causal role for etanercept in the development of inflammatory ocular disease, most notably acute anterior uveitis and scleritis, in patients without any history of predisposing inflammatory joint disease [55,56]. An analysis of a German pharmacovigilance database demonstrated a significant increase in the risk of uveitis with etanercept, compared to adalimumab or infliximab [57].…”

Uveitis

“…33 These include TNF antagonists (adalimumab, infliximab, certolizumab, golimumab, etanercept) Anti-CD20 drugs (rituximab) Interleukin-6 receptor antagonist (tocilizumab) Interleukin-1 receptor antagonist (anakinra) Interferon-alpha Anti-CD80/86 drugs (blocks costimulatory signals from antigen-presenting cells) (abatacept) Vascular endothelial growth factor antagonists (bevacizumab, ranibizumab) (for macular edema) Among these biologic agents, experience is greatest with the TNF antagonists adalimumab and infliximab. Paradoxically, etanercept may increase the risk of uveitis and scleritis, 44 so that other TNF antagonists are preferred for ocular inflammation.…”