ACR 2019


Conference summaries

Spondyloarthritis Including Psoriatic Arthritis

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

Presented by: Damien Roche, MD
Aix-Marseille University, CHU Marseille, Dept. of Rheumatology, Marseille, France
  • In RCTs investigating TNF-i and anti-IL17A antibodies in patients with axial spondyloarthritis, incident AU or IBD are rare events.

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. [1] 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.

  • To assess and compare the incidence of IBD and AU in axSpA patients treated with TNF-i or anti-IL17A antibodies.

Selection of studies

  • A systematic review of the literature was performed to search for randomized controlled trials with anti-TNF or anti-IL17 agents versus placebo or an active comparator.
  • The MEDLINE, EMBASE and COCHRANE databases were consulted until April 4, 2019.
  • Compounds assessed: infliximab, certolizumab, golimumab, adalimumab, etanercept, ixekizumab, secukinumab.

Main inclusion criteria

  • English or French language.
  • Randomized controlled trial (RCT).
  • Adult axSpA according to ASAS or New York modified criteria.
  • TNF-i or anti-IL17A antibody vs. placebo or active comparator (at least 2 RCTs with the same comparator).
  • Data on AU or IBD reported the safety section of the article.
  • 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.



  1. 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.

Written by: Patrick Moore, PhD

Reviewed by: Alessia Alunno, MD, PhD

Local reviewers: Alessia Alunno, MD, PhD (Italian); Aurélie Najm, MD (French); Yukinori Okada, MD, PhD (Japanese); Fabian Proft, MD (German); Javier Rodríguez-Carrio, MD, PhD (Spanish); Priscilla Wong, MD (Chinese)

Scientific Editor:  Leonard H. Calabrese, DO


A Comparative Analysis of Upadacitinib Monotherapy and Upadacitinib Combination Therapy for the Treatment of Rheumatoid Arthritis from Two Phase 3 Trials

Presented by: Maya H. Buch, MD, PhD - University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom

Rheumatoid Arthritis Treatment with Filgotinib: Week 156 Safety and Efficacy Data from a Phase 2b Open-Label Extension Study

Presented by: Arthur Kavanaugh, MD - University of California, San Diego School of Medicine, La Jolla, CA, USA


A Phase 1b/2a Trial of Tofacitinib, an Oral Janus Kinase Inhibitor, in Systemic Lupus Erythematosus

Presented by: Sarfaraz Hasni, MD - National Institute of Arthritis, Musculoskeletal, and Skin diseases/ National Institutes of Health, Bethesda, MD, USA

A Phase 3 Randomized Controlled Trial of Anifrolumab in Patients with Moderate to Severe Systemic Lupus Erythematosus

Presented by: Richard A. Furie, MD - Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA


The Burden of Comorbidity in Patients with RA, PsA or SPA in a General Practice Registry

Presented by: Diederik De Cock, PhD - KU Leuven, Leuven, Belgium



Ixekizumab Demonstrates Improvement Comparable to Adalimumab Across ACR Components in Biologic-Naïve Patients with Psoriatic Arthritis

Presented by: M. Elaine Husni, MD, MPH - Dept. of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA

Tildrakizumab Efficacy on Psoriasis in Patients with Psoriatic Arthritis—An Analysis from a Phase 2 Study

Presented by: Alan M. Mendelsohn, MD - Sun Pharmaceutical Industries, Inc., Princeton, NJ, USA, Princeton, NJ, USA

Development of a Set of ASAS Quality Standards for Adults with Axial Spondyloarthritis

Presented by: Uta Kiltz, MD - Rheumazentrum Ruhrgebiet/Ruhr University Bochum, Herne, Germany

Ixekizumab in Non-Radiographic Axial Spondyloarthritis: Primary Results from a Phase 3 Trial

Presented by: Atul Deodhar, MD, MRCP - Oregon Health & Science University, Portland, OR, USA


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