Efficacy of anti–tumor necrosis factor therapy for extra-articular manifestations in patients with ankylosing spondylitis: a meta–analysis

Abstract

BackgroundWe performed a meta-analysis to evaluate the effect of anti–tumor necrosis factor (TNF) therapy on the frequency of extra–articular manifestations (EAMs) in patients with ankylosing spondylitis (AS).MethodsWe searched with the terms ‘ankylosing spondylitis’, ‘infliximab’, ‘etanercept’, ‘adalimumab’, ‘golimumab’, ‘certolizumab’, ‘TNF inhibitor/blocker/antagonists’ or ‘anti-TNF’ on MEDLINE, EMBASE and Cochrane Library for randomized controlled trials (RCTs) of ≥12 weeks with parallel or crossover design of TNF inhibitor versus placebo to treat uveitis, inflammatory bowel disease (IBD) and/or psoriasis of AS, published before February 2014.ResultsWe found 8 RCTs that fit our criteria. Anti–TNF therapy was associated with less uveitis than placebo in patients with AS (OR: 0.35, 95% CI: 0.15–0.81, P = 0.01). Subgroup analysis showed receptor fusion proteins were more efficacious for uveitis than placebo (OR: 0.30, 95% CI: 0.09–0.94, P = 0.04), but monoclonal antibodies were not (OR: 0.43, 95% CI: 0.12–1.49, P = 0.18). Anti–TNF therapy and placebo group did not significantly differ in treating IBD in AS patients (OR: 0.75, 95% CI: 0.25–2.29, P = 0.61). In subgroup analysis, neither monoclonal antibodies (OR: 0.45, 95% CI: 0.10–1.92, P = 0.28) nor receptor fusion proteins (OR: 1.52, 95% CI: 0.25–9.25, P = 0.65) significantly differed from placebo in treating IBD. We found no suitable reports on psoriasis.ConclusionsAnti–TNF therapy was preventive for flares or new onset of uveitis in AS patients, and might be an alternative for these patients. However, monoclonal anti–TNF antibodies and TNF receptor fusion proteins were not efficacious for IBD in AS patients.

Tumour necrosis factor inhibitor treatment and occurrence of anterior uveitis in ankylosing spondylitis: results from the Swedish biologics register

“…In addition, data derived from adverse drugs events reporting (not including cases with AS) have supported this finding 24. In contrast, a recent meta-analysis, based on eight RCT of TNFi in AS, reported a contradictory finding, where ETN appeared to be more effective against uveitis than the monoclonal therapies 19. However, in this latter meta-analysis, none of the RCTs included was designed to specifically investigate the effect of TNFi on AU, and the numbers of AU events were small, which may explain the discrepant results.…”

“…However, the previous studies have been heterogeneous in both design and in reporting of data, and two meta-analyses incorporating observational studies and randomised controlled trials (RCT) have reported conflicting results 10 19. Additional data are thus needed to elucidate whether TNFi have differential effects with regard to preventing AU.…”

The Safety Profile of Tumor Necrosis Factor Inhibitors in Ankylosing Spondylitis: Are TNF Inhibitors Safer Than We Thought?

“…The prognosis of uveitis is generally good for those who receive appropriate treatment, but serious complications, including permanent vision loss, may result if left untreated. TNF inhibitors can prevent the recurrence of uveitis . Yet this may be not true for ETN (Table ).…”

Use of Nonsteroidal Anti-Inflammatory Drugs and Biological Agents for the Treatment of Axial Spondyloarthritides. Recommendations of the Spondyloarthritis Study Group of Experts, All-Russian Public Organization «the Association of Rheumatology of Russia»

“…Антитела к растворимым рецепторам ФНОα (этанерцепт) при лечении пациентов с передним увеитом и АС не противопоказаны и могут быть назначены в отдель-ных клинических ситуациях (непереносимость/неэффек-тивность других препаратов, высокий риск реактивации туберкулезной инфекции, мнение эксперта и др.) [50]. Эф-фективность иИЛ17А (секукинумаб) при лечении передне-го увеита не доказана [7].…”