Preventive effect of anti-TNF antibodies versus nonsteroidal anti-inflammatory drugs on occurrence of uveitis in patients with ankylosing spondylitis

Abstract

Objectives To compare the effect of tumor necrosis factor (TNF) inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs) on uveitis in patients with ankylosing spondylitis (AS). Methods This retrospective cohort study included 1055 AS patients managed at Seoul National University Hospital from 2004–2016. Data (medical history,including uveitis) were obtained from medical records. Treatment episodes were assigned to NSAIDs (n=704), anti-TNF antibody (n=517), and soluble TNF receptor fusion protein (TNF receptor) groups (n=341). A Cox proportional hazard model was used to compare the incidence of uveitis in each group. The incidence rates of uveitis before and after initiation of TNF inhibitors were assessed. A propensity score-matched (PSM) comparison was performed for sensitivity analysis. Results Uveitis was significantly less common in patients receiving anti-TNF antibody than in those receiving NSAIDs (adjusted hazard ratio (HR), 0.53

95% confidence interval (CI), 0.29–0.96). Anti-TNF antibody plus NSAIDs further reduced the incidence of uveitis (adjusted HR, 0.39

95% CI, 0.19–0.79). Combination therapy was preventive in AS patients with a history of uveitis (adjusted HR, 0.31

95% CI, 0.12–0.81) but not in those without history of uveitis. The incidence rate of uveitis fell from 6.36 to 2.60 per 100 person-years when anti-TNF antibody was added to NSAIDs (incidence rate ratio, 0.41

95% CI, 0.23–0.68). PSM analysis yielded similar results. Conclusions Anti-TNF antibody plus NSAIDs reduces the risk of uveitis to a greater extent than NSAIDs alone in AS patients with a history of uveitis. Combination treatment may be an effective secondary prevention measure.