Anti-TNFα agents and methotrexate in spondyloarthritis related uveitis in a Chinese population

Abstract

This study seeks to evaluate the clinical characteristics of spondyloarthritis (SpA)-related uveitis in a cohort from South China and to assess the efficacy and safety of therapies based on TNF blockers. SpA patients with uveitis admitted to a south China hospital were enrolled. Demographic information, clinical characteristics, laboratory findings, intraocular inflammation, visual acuity, macular thickness, and treatments were documented. Of the 1,036 SpA patients reviewed, 182 had uveitis. Ankylosing spondylitis (AS) was the most common subtype. Unilateral uveitis was found in 51 cases (51/182, 28.0%), and unilateral alternating uveitis was found in 75 cases (75/182, 41.2%). Half of the cases were recurrent uveitis (52.2%), and acute onset was common (76.4%). The most serious complication was vision loss (0.5%). No significant difference in disease activity was found between the SpA patients with or without uveitis. Predominant improvements were found in cases treated with all three anti-TNFs (infliximab, adalimumab, and etanercept) and anti-TNFs plus methotrexate (MTX). Monotherapy of methotrexate was not adequate for inducing remission. Monotherapy of etanercept was not as effective as adalimumab and infliximab, mainly in the prevention of recurrence. No significant difference in effectiveness was found among the three anti-TNFs if MTX was added. Etanercept plus MTX were well tolerated. Infliximab and adalimumab were associated with more tuberculosis and/or hepatitis flares. Uveitis is common in SpA patients. Severe complications may develop in prolonged and intractable cases. Treatments based on anti-TNFs had good clinical response, and better safety documentation were observed in etanercept plus MTX compared to the other two anti-TNF monoclonal antibodies plus MTX.

Uveitis in spondyloarthritis

“…77,129,134 The ACR treatment recommendation for axSpA patients with recurrent uveitis advises treatment with TNFi monoclonal antibodies over treatment with other biologics (PICO 29). 77 This recommendation is based on indirect comparison of the AAU flares in seven observational studies with adalimumab, infliximab, etanercept, [125][126][127][135][136][137][138] one study with pooled data from four RCTs and three observational studies of infliximab and etanercept 122 and the RCTs of secukinumab. 129,134 The latter showed no difference between secukinumab and placebo.…”

Rare occurrence of inflammatory bowel disease in a cohort of Han Chinese ankylosing spondylitis patients- a single institute study

“…In Han Chinese, favorable outcomes from the ADA usage have been observed in rheumatological disorders other than AS like rheumatoid arthritis, psoriasis and psoriatic arthritis 36 – 38 . For the AS-related uveitis, in addition to no recurrences after the ADA therapy in this study, an earlier report from China demonstrates the clinical response to TNF blockades; however, monotherapy of ETA is not as effective as ADA in preventing the recurrence unless with the additional methotrexate usage 39 . Furthermore, regarding the ADA therapy in CD, the efficacy has been demonstrated in moderate to severe victims in Taiwan with more stringent clinical usage criteria than in western countries, whereas higher remission rates are observed in patients from China than those in clinical trials from the western countries 40 .…”

Characteristics of Administration of Nonsteroidal Anti-Inflammatory Drugs in Ankylosing Spondylitis: Clinical Observation

“…В про-филактике рецидивов АС монотерапия метотрексатом оказалась недостаточно эффективна. Лучшие результаты были достигнуты в этом отношении при на-значении метотрексата в сочетании с иФНО-α (этанер-цептом) [14]. Важно, что назначение синтетических или генно-инженерных биологических препаратов не является основанием для отмены НПВП при АС.…”