Anti-TNF Drugs for Chronic Uveitis in Adults—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Frontiers in Medicine

article

Inês Leal¹  Filipe B. Rodrigues³  David Cordeiro Sousa¹  Gonçalo S. Duarte³  Vasco C. Romão⁵  Carlos Marques-Neves¹  João Costa³  João Eurico Fonseca⁵ 

[1] Department of Ophthalmology, Hospital de Santa Maria;Universidade de Lisboa;Laboratório de Farmacologia Clínica e Terapêutica, Universidade de Lisboa;Clinical Pharmacology Unit, Instituto de Medicina Molecular, Universidade de Lisboa;Department of Rheumatology, Hospital de Santa Maria;Rheumatology Research Unit, Instituto de Medicina Molecular, Universidade de Lisboa

关键词: non-infectious uveitis;    anti-tumor necrosis factor drugs;    adalimumab;    etanercept;    safety;    efficacy;   

DOI  :  10.3389/fmed.2019.00104

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: We aimed to assess efficacy and safety of anti-tumor necrosis factor (TNF) drugs for adult chronic non-infectious uveitis (NIU). Methods: CENTRAL, MEDLINE, and EMBASE, were searched from inception to January 2019. Double-masked randomized placebo-controlled trials, assessing any anti-TNF vs. best medical intervention/standard of care in adults with chronic NIU were considered. The PRISMA and SAMPL guidelines were followed. The risk of bias was assessed using the Cochrane risk of bias tool. Overall quality of the evidence was assessed according to GRADE. PROSPERO registration: #CRD42016039068. The primary efficacy and safety outcomes were preservation of visual acuity (VA) and withdrawals due to adverse events, respectively. Meta-analysis of efficacy analysis was not performed due to significant clinical heterogeneity between studies' population and interventions. Results: A total of 1,157 references were considered and 3 studies were included. The overall risk of bias was moderate. In active NIU, adalimumab group showed an increased likelihood of VA preservation (risk ratio (RR) 1.75, 95%CI 1.32 to 2.32, n = 217), whereas the etanercept group did not (RR 0.81, 95%CI 0.57 to 1.14, n = 20). In inactive NIU, adalimumab was associated with increased likelihood of VA preservation (RR 1.31, 95%CI 1.12 to 1.53, n = 226). The rate of adverse events did not differ between anti-TNF and control arms (RR 1.03, 95%CI 0.94 to 1.13, n = 410). Conclusions: There is high quality evidence that adalimumab decreases the risk of worsening VA in active and inactive NIU and very low quality evidence that the risk of etanercept worsening VA in inactive NIU is not different from placebo. Moderate quality evidence suggests that anti-TNF agents are not different from placebo on the risk of study withdrawal.

【 授权许可】

CC BY