Monoclonal TNF inhibitors outperform secukinumab, etanercept for preventing uveitis in SpA
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Secukinumab and etanercept are associated with an increased risk for anterior uveitis in patients with spondyloarthritis, compared with monoclonal TNF inhibitors, according to data published in the Annals of the Rheumatic Diseases.
“For [anterior uveitis (AU)], TNF inhibitors reduce the frequency of flares in [axial SpA], and the presence of AU has been linked to a better TNF inhibitors treatment retention, but the protective effects regarding AU seem to be less for etanercept than for monoclonal TNF inhibitors,” Ulf Lindström, MD, PhD, of the University of Gothenburg, in Sweden, and colleagues wrote.
“Further, TNF inhibitors are effective in a wide range of other forms of uveitis, while subcutaneous secukinumab is ineffective in non-SpA uveitis,” they added. “Based on currently available data, the 2019 American College of Rheumatology recommendations for management of axSpA therefore stress the need for more evidence regarding the role of [IL-17 inhibitors (IL-17i)] in the treatment of axSpA patients with AU.”
To examine the risk for anterior uveitis during treatment with secukinumab (Cosentyx, Novartis) for SpA, compared with TNF inhibitors, Lindström and colleagues conducted a retrospective observational study using data from the Swedish Rheumatology Quality Register. The researchers used the register to identify 3,616 patients with SpA who started a TNF inhibitor from 2015 through 2018. In all, these patients contributed 4,851 treatment starts to the data, including 456 for secukinumab and 4,395 for any TNF inhibitor.
To identify occurrences of anterior uveitis, the researchers reviewed diagnosis codes in outpatient ophthalmology care in the National Patient Register.
Main outcomes included crude rates of anterior uveitis diagnoses per 100 patient-years, as well as adjusted hazard ratios for anterior uveitis, during treatment in those who did not have the condition during the year prior to therapy initiation. The researchers adjusted hazard ratios for age, sex, history of anterior unveitis and patient global assessment of disease activity.
According to the researchers, the rate of anterior uveitis diagnoses per 100 patient-years was 6.8 (95% CI, 5.2-8.7) for secukinumab. Rates for TNF inhibitors, meanwhile, varied from 2.9 (95% CI, 2.1-3.7) for infliximab (Remicade, Janssen, Johnson & Johnson), to 4 (95% CI, 3.3-4.9) for adalimumab (Humira, AbbVie) to 7.5 (95% CI, 6.7-8.4) for etanercept (Enbrel, Amgen).
The adjusted hazard ratios for first anterior uveitis, using adalimumab as a reference, were 2.32 (95% CI, 1.16-4.63) for secukinumab, 0.99 (95% CI, 0.49-1.96) for infliximab, 1.82 (95% CI, 1.13-2.93) for etanercept, 1.59 (95% CI, 0.9-2.8) for golimumab (Simponi, Janssen) and 1.12 (95% CI, 0.44-2.83) for certolizumab (Cimzia, UCB).
Sensitivity analyses confirmed the association of higher anterior uveitis rates with secukinumab and etanercept, compared with the TNF inhibitors, the researchers wrote.
“Regardless of type of TNF inhibitors or secukinumab, new-onset AU is rare during biological treatment,” Lindström and colleagues wrote. “Furthermore, the monoclonal TNF inhibitors appear to be more effective choices for preventing AU in SpA patients, compared with etanercept and secukinumab.”
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