Wendling Daniel, Joshi Avani, Reilly Patrick, Jalundhwala Yash J, Mittal Manish, Bao Yanjun
University of Franche-Comté and CHU de Besançon, Department of Rheumatology , Besançon , France.
Curr Med Res Opin. 2014 Dec;30(12):2515-21. doi: 10.1185/03007995.2014.969368. Epub 2014 Oct 8.
To compare the risk of developing uveitis in patients initiating anti-tumor necrosis factor (anti-TNF) agents (adalimumab, etanercept, and infliximab) for ankylosing spondylitis (AS).
Anti-TNF-naive patients with a diagnosis of AS and without a history of uveitis (N = 2115) who subsequently initiated anti-TNF therapy for AS were identified in a large claims database (2005 to 2011). A multivariate Cox proportional-hazards model was used to compare the risk of uveitis in patients who received etanercept or infliximab vs adalimumab.
The median number of days to the first occurrence of uveitis after initiation of anti-TNF was 191. Among the three anti-TNF groups, the median time to event of uveitis was longest in patients taking adalimumab (243 days), followed by etanercept (182 days) and infliximab (144 days). The incidence rate for uveitis over 1 year was lowest for patients who received adalimumab (2.4%, N = 717), highest for patients who received etanercept (4.5%, N = 1087), and intermediate for patients who received infliximab (3.2%, N = 311). The risk of uveitis was 1.9 times higher in patients receiving etanercept compared with those taking adalimumab (hazard ratio [HR]: 1.91, 95% confidence interval [CI]: 1.1 to 3.31). For patients taking infliximab, the risk of uveitis was not statistically significantly different (HR: 1.35, 95% CI: 0.62 to 2.95) compared to adalimumab.
The results indicated that initial adalimumab therapy is associated with a significantly lower risk of developing uveitis compared to initial etanercept therapy in patients diagnosed with AS and no prior history of uveitis; however, the risk was not different between adalimumab and infliximab. Limitations to consider when interpreting this conclusion include that disease-level clinical data, such as disease duration, were not available for inclusion in the model and that risk of uveitis beyond 1 year was not evaluated.
比较强直性脊柱炎（AS）患者开始使用抗肿瘤坏死因子（抗TNF）药物（阿达木单抗、依那西普和英夫利昔单抗）后患葡萄膜炎的风险。
在一个大型索赔数据库（2005年至2011年）中，识别出诊断为AS且无葡萄膜炎病史的未使用过抗TNF药物的患者（N = 2115），这些患者随后开始接受AS的抗TNF治疗。使用多变量Cox比例风险模型比较接受依那西普或英夫利昔单抗治疗的患者与接受阿达木单抗治疗的患者患葡萄膜炎的风险。
开始使用抗TNF药物后首次发生葡萄膜炎的中位天数为191天。在三个抗TNF药物组中，服用阿达木单抗的患者发生葡萄膜炎的事件中位时间最长（243天），其次是依那西普（182天）和英夫利昔单抗（144天）。接受阿达木单抗治疗的患者1年内葡萄膜炎的发病率最低（2.4%，N = 717），接受依那西普治疗的患者最高（4.5%，N = 1087），接受英夫利昔单抗治疗的患者居中（3.2%，N = 311）。与服用阿达木单抗的患者相比，接受依那西普治疗的患者患葡萄膜炎的风险高1.9倍（风险比[HR]：1.91，95%置信区间[CI]：1.1至3.31）。对于服用英夫利昔单抗的患者，与阿达木单抗相比，患葡萄膜炎的风险无统计学显著差异（HR：1.35，95%CI：0.62至2.95）。
结果表明，在诊断为AS且既往无葡萄膜炎病史的患者中，与初始依那西普治疗相比，初始阿达木单抗治疗后患葡萄膜炎的风险显著更低；然而，阿达木单抗和英夫利昔单抗之间的风险无差异。解释该结论时需考虑的局限性包括，疾病水平的临床数据，如病程，未纳入模型，且未评估1年以上葡萄膜炎的风险。
