Friday, 19 Oct 2018

You are here

Uveitis Events Reduced with Select TNF Inhibitors

Uveitis may occur in up to 40% of spondyloarthritis patients. Metanalyses have shown that treatment with tumour necrosis factor-α inhibitor (TNFi) may reduce the rates of anterior uveitis (AU).  A multicenter study from Sweden and Norway has confirmed that amongst TNFi, adalimumab (ADA) and infliximab (IFX) offer better protection against AU than etanercept (ETN).

Real world data was extracted from the Swedish Rheumatology Quality Register and examined ankylosing spondylitis patients from multiple centers starting ADA, ETN or IFX as their first TNFi between 2003 - 2010. The study included 1365 ankylosing spondylitis patients (406 ADA, 354 ETN, 605 IFX), and they examined AU rates prior to and after TNFi initiation.

AU rates with ADA and IFX therapy were decreased, while ETN was associated with an increase compared to pretreatment rates. The adjusted HRs for AU on ETN were higher compared to ADA and IFX (ETN HR: 3.86 95% CI 1.85 to 8.06; IFX HR: 1.99, 95% CI 1.23 to 3.22). There were no differences in rates seen between IFX and ADA.

These real world data confirm prior collective observations suggesting that monoclonal antibody based TNFi (ADA, IFX) have a clear advantage over ETN in preventing uveitis. 

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Higher Infection Rates for Infliximab in Psoriasis

A prospective study of psoriasis patients from the British Association of Dermatologists Biologic Interventions Register demonstrated that infliximab therapy yielded 2-3 times more serious infection than seen in those treated with non-biologic DMARDs or methotrexate (MTX).

Biomarker Combo Predicts TNF Inhibitor Responses

Based on clinical trial data, patients starting tumour necrosis factor-alpha inhibitors (TNFi) have roughly a two-thirds chance of achieiving a good clinical response. French investigators have studied a series of potential biomarkers and surmised that the combination of baseline prealbumin, platelet factor 4 and S100A12 can predict a 78% response to TNFi in rheumatoid arthritis (RA) patients.

TNF Inhibitors Don't Increase Cancer Risk in Children

While the risk of neoplasia with tumour necrosis factor inhibitor (TNFi) use has been largely nullified in most inflammatory disorders, this risk in children is less certain. However a recent study shows no risk of increased cancer in children treated with TNFi for juvenile idiopathic arthritis (JIA), pediatric inflammatory bowel disease (pIBD) and pediatric plaque psoriasis (pPsO).

Risk of Psoriasis Complicating TNF Inhibitor Therapy

A population-based study of claims data from Korea shows that among inflammatory bowel disease (IBD) patients receiving tumour necrosis factor inhibitors (TNFi) there is a 3.7 per 100 patient-year risk of paradoxically developing psoriasis - a rate that is roughly 3-fold higher than risk in TNFi-naive IBD patients.

Favorable Certolizumab Safety Profile in Pregnancy

Clowse and colleagues have published an extensive review of the certolizumab pegol (CZP) in pregnancy database, and found no evidence that CZP has a teratogenic effect or contributes to fetal harm when compared to the general population.