Study Shows TNF Inhibitors Prevent Relapse of Uveitis in Most Patients with Ankylosing Spondylitis

AUGUST 26, 2016
Ellen Kurek
Although the main articular manifestation of ankylosing spondylitis (AS) is inflammation of the intervertebral joints, one of its main extra-articular manifestations is acute anterior uveitis. The prevalence of uveitis in AS patients varies depending on the patient population studied. However, a meta-analysis of 143 reports found that the pooled prevalence of uveitis in AS patients was 26%, and that this prevalence increased with alongside the duration of AS.
Human Leukocyte Antigen (HLA)-B27 is frequently found in AS patients and is the most common cause of acute anterior uveitis. In North America and Europe, the prevalence of HLA-B27 is approximately 8% to 10%, but the prevalence of the HLA-B27 allele in patients with acute anterior uveitis is much higher, ranging from 15% to 60%.
Most patients with HLA-B27-associated uveitis have acute or recurrent inflammation, but some may have chronic inflammation, defined as uveitis that lasts longer than 3 months or that requires long-term therapy. Chronic uveitis develops in approximately 5% to 19% of patients with HLA-B27-associated uveitis and is associated with a 7-fold increase in the risk of visual impairment. Moreover, poor control of inflammation has been associated with the development of ocular complications including vision loss.
Current guidelines recommend using biological agents to treat more severe or advanced uveitis. The anti-tumor necrosis factor alpha (anti-TNFα) agents adalimumab (Humira, Abbvie) and infliximab (Remicade, Janssen) are the biological agents most frequently used for uveitis. Etanercept (Enbrel, Amgen) has also been used, but it appears to be less effective in treating ocular inflammation than systemic inflammation.

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