Occurrence of anterior uveitis in patients with spondyloarthritis treated with tumor necrosis factor inhibitors: comparing the soluble receptor to monoclonal antibodies in a large observational cohort

Abstract Background: The objective of this study was to compare in real life the occurrence of anterior uveitis in patients with spondyloarthritis (SpA), including psoriatic arthritis (PsA), treated with the soluble-receptor etanercept (ETA) or monoclonal antibodies (mAb). Methods: This was an observational, retrolective study. Patients with SpA who were prescribed anti-TNF agents between 2000 and 2014 were included. The risk of uveitis was interpreted qualitatively (number of subjects with at least one uveitis) and quantitatively (number of uveitis flares for each individual). Models were adjusted for propensity score of receiving preferentially mAbs or ETA.Results: 429 patients were included (302 with SpA and 127 with PsA); 203 received a mAb and 226 ETA as a first TNF-a inhibitor. Probability of uveitis occurring during the first year of treatment was lower with ETA than mAbs but not significantly (odds ratio 0.94 [95% confidence interval 0.35; 2.54], p=0.90, on qualitative analysis and relative risk 0.62 [0.26; 1.46], p=0.27, on quantitative analysis) after adjustment for the propensity score. The over-time risk of uveitis was numerically higher with ETA than mAbs, but the differences were not statistically significant. Conclusion: In this observational study, the risk of uveitis in patients with SpA does not appear to be greater with ETA than mAbs treatment. The occurrence of uveitis in patients receiving an anti-TNF-a agent seems linked more to history of uveitis than the prescribed molecule.