Systematic Literature Review and Network Meta-Analysis Comparing Incidence of Anterior Uveitis and IBD in Axial Spondyloarthritis Patients Treated with Anti-TNF versus Anti-IL17A in Controlled Randomized Trials
Damien Roche, MD
Aix-Marseille University, CHU Marseille, Dept. of Rheumatology, Marseille, France
Inflammatory bowel diseases (IBD) and anterior uveitis (AU) are frequent extra-articular features of axial spondyloarthritis (axSpA) with an estimated prevalence between 26% and 33% for AU and 5% and 8% for IBD.  While the effects of TNF inhibitors (i) on IBD and AU are well known, less evidence is available on the incidence of IBD and AU in patients treated with anti-IL17A antibodies.
31 RCTs were included in the meta-analysis, involving 2210 patients treated with placebo, 2101 treated with a TNF-i, and 1177 with an anti-IL17 agent. This allowed to have data for 2374 patient-years of treatment.
The incidence of AU and IBD are shown in the Table.
Regarding AU, the following incidences were found:
TNF-i (monoclonal antibodies) vs. placebo: OR=0.50 (95% CI 0.26-0.97), p=0.04;
TNF-i (soluble receptor) vs. placebo: OR=0.50 (95% CI 0.20-1.26) p=0.14;
anti-IL17A (monoclonal antibodies) vs. placebo: OR=1.35 (95% CI 0.47-3.89) p=0.59.
Regarding IBD, the following incidences were found:
TNF-i (monoclonal antibodies) vs. placebo: OR=0.61 (95% CI 0.24-1.53), p=0.29;
TNF-i (soluble receptor) vs. placebo: OR=1.06 (95% CI 0.37-3.07) p=0.92;
anti-IL17 (monoclonal antibodies) vs. placebo: OR=1.20 (95% CI 0.37-3.96) p=0.76.
There were no significant differences between groups considering disease duration, diagnosis of ankylosing spondylitis, and detailed history of AU/IBD vs. no description.
In RCTs assessing TNF-i and anti-IL17A antibodies in patients with axSpA, incident AU or IBD are rare events.
Key messages/Clinical perspectives
This network meta-analysis suggests that anti-TNF MAb and anti-IL17A are, respectively, the most and least protective classes against flare or new onset of AU and IBD in patients with axial spondyloarthritis.
de Winter JJ, van Mens LJ, van der Heijde D, et al. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther. 2016 Sep 1;18:196.
Presenter disclosure: The presenter has reported that no relationships exist relevant to the contents of this presentation.