Incidence of anterior uveitis in patients with axial spondyloarthritis treated with anti-TNF or anti-IL17A: a systematic review, a pairwise and network meta-analysis of randomized controlled trials

Arthritis Research & Therapy

Pierre Lafforgue¹  Thao Pham¹  Martin Badard¹  Damien Roche²  Laurent Boyer³ 

[1] APHM, CHU Sainte-Marguerite, Rheumatology Department, Aix Marseille Univ., Marseille, France;APHM, CHU Sainte-Marguerite, Rheumatology Department, Aix Marseille Univ., Marseille, France;Rheumatology Department, Saint Joseph Hospital, 26 Boulevard de Louvain, 13285, Marseille, France;School of Medicine, La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Aix Marseille Univ., Marseille, France;

关键词: Axial spondyloarthritis;    Meta-analysis;    Anti-TNF;    Anti-IL17A;    Uveitis;   

DOI  :  10.1186/s13075-021-02549-0

来源: Springer

【 摘 要 】

BackgroundAnterior uveitis (AU) is the most frequent extra-articular feature of axial spondyloarthritis (axSpA). We aimed to assess and compare the incidence of AU in axSpA patients treated with anti-TNF or anti-IL17A.MethodsWe systematically reviewed PubMed, EMBase, and Cochrane from inception to May 3, 2020, and searched for placebo-controlled and head-to-head randomized controlled trials (RCTs) assessing anti-TNF monoclonal antibodies (mAb) or soluble receptor fusion protein or anti-IL17A in patients with axSpA according to ASAS criteria and reporting safety data on AU. Data were extracted following a predefined protocol. We did pairwise and network meta-analyses for the primary outcome of AU flares (relapse or de novo) incidence and estimated summary odds ratios (ORs). We assessed the quality of evidence using the Cochrane risk-of-bias 2.0 tool. We ranked treatments according to their effectiveness in preventing AU flare using the P-score.ResultsWe identified 752 citations and included 33 RCTs, comprising 4544 treated patients (anti-TNF mAb 2101, etanercept [ETN] 699, anti-IL17A 1744) and 2497 placebo-receiving patients. Incidence of uveitis was lower with anti-TNF mAb versus placebo (OR = 0.46; CI 95% [0.24; 0.90]) and versus anti-IL17A (OR = 0.34; CI 95% [0.12; 0.92]. According to the P-score, the ranking from the most to the least preventive treatment of uveitis flare was as follows: anti-TNF mAb, ETN, placebo, and anti-IL17A.ConclusionIn RCTs assessing anti-TNF and anti-IL17A in axSpA, incident uveitis are rare events. However, this network meta-analysis demonstrates that anti-TNF mAb are associated with a lower incidence of uveitis compared to placebo and anti-IL17A.

【 授权许可】

CC BY