The incidence of uveitis in patients with axial spondylarthritis treated with biologics or targeted synthetics: a systematic review and network meta‐analysis

Abstract

ObjectiveUveitis is a common extra‐articular manifestation of axial spondylarthritis (AxSpA). We set to evaluate risk of anterior uveitis (AU) with biologics and synthetic disease‐modifying drugs in AxSpA.MethodsWe conducted a systematic review and meta‐analysis to identify phase II/III double blinded randomised controlled trials of anti‐TNF monoclonal antibodies (mAb) anti‐IL17 and JAK inhibitors (JAKi) in AxSpA. Patient‐exposure years (PEY) were calculated using per‐protocol approach. Incidence rate (IR) of AU /100 person‐years were calculated by treatment group using random effects approach. Network meta‐analysis (NMA) was used to estimate risk of AU in treatment groups, expressed as incidence rate ratios (IRR). Bias was assessed using Cochrane Risk of Bias‐2 tool.ResultsForty‐four trials were included: 17 anti‐TNF mAb (1004 PEY), 9 etanercept (180 PEY), 13 anti‐IL17 (1834 PEY) and 6 JAKi (331 PEY). IR of AU were anti‐TNF mAb: 4.1 [95%CI 0, 8.5], etanercept: 5.4[0, 16.0], anti‐IL17: 2.8 [1.6, 4.1] JAKi: 1.5 [0.0, 3.0] and placebo: 10.8 [7.4, 14.1]. In NMA, IRR of treatments compared with placebo were anti‐TNF mAb: 0.32[0.10,1.04], etanercept 0.42 [0.08, 2.38], anti‐IL17: 0.43[0.19, 0.98] and JAKi: 0.32[0.06, 1.67]. Comparisons between anti‐TNF mAb, anti‐IL17 and JAKi did not demonstrate any significant difference in AU risk. Using the SUCRA approach to rank AU risk, anti‐TNF mAbs were associated with the lowest risk followed by JAKi, anti‐IL17 and etanercept. All treatments were ranked superior to placebo.ConclusionAnti‐TNF mAbs, JAKi and anti‐IL17 appear protective against AU events in individuals with AxSpA, with no significant differences in risk of AU between treatments.This article is protected by copyright. All rights reserved.