Original article
Anti-TNFα Treatment for HLA-B27-Positive Ankylosing Spondylitis–Related Uveitis

https://doi.org/10.1016/j.ajo.2016.07.016Get rights and content

Purpose

To assess the long-term efficacy of the most widely used anti–tumor necrosis factor alpha (TNFα) agents for treatment of HLA-B27-positive ankylosing spondylitis (AS)-related uveitis.

Methods

The medical records of 143 patients with HLA-B27-positive AS who visited Seoul St. Mary's Hospital and were taking an anti-TNFα agent for at least 1 year were studied. Subjects were divided into 3 groups according to anti-TNFα treatment: Group 1 (infliximab, 66), Group 2 (adalimumab, 45), and Group 3 (etanercept, 32).

Results

Mean age was 41.0 ± 13.0 years, and 97 patients (67.8%) were male. Mean follow-up period was 70.6 ± 37.9 months. In cases of active ocular inflammation at the onset of anti-TNFα treatment, patients showed improved activity of uveitis after 24.0 ± 15.0 days (Group 1), 17.9 ± 6.0 days (Group 2), and 25.9 ± 18.0 days (Group 3). After the anti-TNFα treatment, 71 of 94 patients (32 [76.2%] in Group 1, 26 [78.8%] in Group 2, and 13 [68.4%] in Group 3) remained without uveitis relapse. A reduction in the number of systemic medications was achieved in 129 patients (90.2%). Twenty-eight cases of minor side effects were observed, and 4 cases were tuberculosis leading to discontinuation of anti-TNFα treatment.

Conclusions

Infliximab, adalimumab, and etanercept were effective for treating and reducing the number of uveitis relapses in HLA-B27-positive AS. However, the risk of serious infections was noted, so ophthalmologists should consider the possibility that prolonged use of biologic agents may result in systemic side effects.

Section snippets

Methods

This retrospective cohort study comprised 143 patients diagnosed with HLA-B27-positive AS. All participants were recruited from May 2006 to August 2015 at Seoul St. Mary's Hospital in South Korea, and a retrospective chart review was conducted. Inclusion criteria were a proven diagnosis of AS, HLA-B27-positive antigen test, and patients who were prescribed an anti-TNFα agent (infliximab, adalimumab, or etanercept) for at least 1 year. AS was diagnosed according to the Modified New York Criteria

Demographic and Clinical Characteristics

Table 1 shows the clinical characteristics of the 143 study participants. Their mean age was 41.0 ± 13.0 years, and 97 patients (67.8%) were male. Table 1 summarizes the demographic and clinical characteristics of uveitis in the 3 groups. Before anti-TNFα treatment, 94 patients (65.7%) (42 [63.6%] in Group 1, 33 [73.3%] in Group 2, and 19 [59.4%] in Group 3) had a history of uveitis. In patients with history of uveitis, anterior uveitis was the most common (37 [88.1%] in Group 1, 32 [97.0%] in

Discussion

In agreement with a number of previously published reports,16, 17, 18, 20, 22, 29, 30, 31 this study showed that all 3 anti-TNFα agents induced improved activity of uveitis and successfully prevented uveitis relapse. However, we are unaware of previous reports regarding the efficacy of anti-TNFα agents in the HLA-B27-positive AS group. This is the report showing uveitis improvement efficacy of anti-TNFα agents in patients with HLA-B27-positive AS.

Infliximab and adalimumab are immunoglobulin

References (46)

  • A. Rothova et al.

    Acute anterior uveitis (AAU) and HLA-B27

    Br J Rheumatol

    (1983)
  • S. Tuncer et al.

    Clinical features and outcomes of HLA-b27-positive and HLA-B27-negative acute anterior uveitis in a Turkish patient population

    Ocul Immunol Inflamm

    (2005)
  • M. Huhtinen et al.

    HLA-B27 typing in the categorisation of uveitis in a HLA-B27 rich population

    Br J Ophthalmol

    (2000)
  • P.D. Sampaio-Barros et al.

    Characterization and outcome of uveitis in 350 patients with spondyloarthropathies

    Rheumatol Int

    (2006)
  • E.M. Dodds et al.

    Posterior segment inflammation in HLA-B27+ acute anterior uveitis: clinical characteristics

    Ocul Immunol Inflamm

    (1999)
  • P. Vassalli

    The pathophysiology of tumor necrosis factors

    Annu Rev Immunol

    (1992)
  • G. Chen et al.

    TNF-R1 signaling: a beautiful pathway

    Science

    (2002)
  • F. Semeraro et al.

    Anti-TNF therapy for juvenile idiopathic arthritis-related uveitis

    Drug Des Devel Ther

    (2014)
  • Y. Shirota et al.

    Biologic treatments for systemic rheumatic diseases

    Oral Dis

    (2008)
  • V. Calvo-Rio et al.

    Anti-TNF-alpha therapy in patients with refractory uveitis due to Behcet's disease: a 1-year follow-up study of 124 patients

    Rheumatology (Oxford)

    (2014)
  • M. Santos Lacomba et al.

    Aqueous humor and serum tumor necrosis factor-alpha in clinical uveitis

    Ophthalmic Res

    (2001)
  • S. Guignard et al.

    Efficacy of tumour necrosis factor blockers in reducing uveitis flares in patients with spondylarthropathy: a retrospective study

    Ann Rheum Dis

    (2006)
  • P.K. Sharma et al.

    Long-term efficacy of systemic infliximab in recalcitrant retinal vasculitis

    Retina

    (2015)
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