MiscellaneousNew Onset of Uveitis During Anti-Tumor Necrosis Factor Treatment for Rheumatic Diseases
Section snippets
Methods
This is a descriptive, retrospective study.
National Survey
Thirty-one cases were recorded, 19 men and 12 women, mean age 43 (5-70) years (Table 1). Other causes of uveitis were excluded (eg, infection). The underlying disease was ankylosing spondylitis (19 cases, 10/12 HLA-B27 positive), psoriatic arthritis (4 cases), rheumatoid arthritis (6 cases), juvenile idiopathic arthritis (2 cases) (Table 2). The mean duration of the disease was 15 (1.5-35) years. The TNF blocker at time of uveitis onset was etanercept 23 times (6 cases after infliximab),
Discussion
In this survey, we gathered 31 cases of new onset of uveitis occurring during anti-TNF therapy, and 121 of such cases available in the English literature. Our series is in accordance with the pooled data of the literature.
Etanercept is the most frequent TNF blocker involved in these cases (23/31 in our series; 103/121 in the literature), suggesting that soluble TNF receptor may be more at risk than monoclonal antibodies regarding the new onset of uveitis. In fact some differences have been
Conclusion
Uveitis occurs de novo under anti-TNF therapy mainly in spondylarthritides, but also in JIA and rheumatoid arthritis patients; this new onset seems more frequent under etanercept, and uveitis is time-limited without discontinuation of the TNF blocker in most of the cases, at least for adult patients. This illustrates a new possibility of a potential paradoxical effect of anti-TNF agents, and rheumatologists and ophthalmologists should be aware of this event.
References (39)
- et al.
Occurrence of uveitis in recently diagnosed juvenile chronic arthritis: a prospective study
Ophthalmology
(2001) - et al.
Anti-TNF therapies in the management of acute and chronic uveitis
Cytokine
(2006) - et al.
Risk of new-onset uveitis in patients with juvenile idiopathic arthritis treated with anti-TNFalpha agents
J Pediatr
(2006) - et al.
Differential effectiveness of etanercept and infliximab in the treatment of ocular inflammation
Ophthalmology
(2006) - et al.
Adalimumab therapy for childhood uveitis
J Pediatr
(2006) - et al.
Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review
Ann Rheum Dis
(2008) - et al.
Adalimumab in the therapy of uveitis in childhood
Br J Ophthalmol
(2007) - et al.
Clinical review: Anti-TNFalpha therapies in uveitis: perspective on 5 years of clinical experience
Ocul Immunol Inflamm
(2009) - et al.
Efficacy of tumour necrosis factor blockers in reducing uveitis flares in patients with spondylarthropathy: a retrospective study
Ann Rheum Dis
(2006) - et al.
Tumour necrosis factor alpha inhibitors in the treatment of childhood uveitis
Rheumatology (Oxford)
(2006)
Decreased incidence of anterior uveitis in patients with ankylosing spondylitis treated with the anti-tumor necrosis factor agents infliximab and etanercept
Arthritis Rheum
Analysis of uveitis rates across all etanercept ankylosing spondylitis clinical trials
Ann Rheum Dis
Adalimumab effectively reduces the rate of anterior uveitis flares in patients with active ankylosing spondylitis: results of a prospective open-label study
Ann Rheum Dis
Do TNF-blockers reduce or induce uveitis?
Rheumatology (Oxford)
Do tumor necrosis factor inhibitors cause uveitis?A registry-based study
Arthritis Rheum
Paradoxical adverse events of anti-tumour necrosis factor therapy for spondyloarthropathies: a retrospective study
Rheumatology (Oxford)
Etanercept (enbrel)-associated inflammatory eye disease: case report and review of the literature
Ocul Immunol Inflamm
Etanercept therapy-associated acute uveitis: a case report and literature review
Clin Exp Rheumatol
Anti-TNF-alpha treatment: a possible promoter in endogenous uveitis?Observational report on six patients: occurrence of uveitis following etanercept treatment
Curr Eye Res
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Tumor necrosis factor-α inhibitor-related autoimmune disorders
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2022, Journal of Allergy and Clinical ImmunologyPharmacologically induced uveitis
2021, Survey of OphthalmologyCitation Excerpt :Etanercept is a humanized, recombinant dimeric fusion of a human Fc molecule and two p75 TNF receptors, which is administered subcutaneously and was the first anti-TNF-α approved by the FDA (1998).229 With TNF-α antagonists, pharmacologically induced uveitis was often reported to be acute anterior uveitis and to occur after a mean of 27 (range, 4 to 96) months following the initiation of the anti-TNF agent.236 Still, there are case reports of uveitis onset occurring 3 weeks to 6 years after initiating therapy and include intermediate uveitis, periphlebitis, and chorioretinitis.
Efficacy and safety of immunomodulatory drugs in patients with non-infectious intermediate and posterior uveitis, panuveitis and macular edema: A systematic literature review
2020, Seminars in Arthritis and RheumatismCitation Excerpt :Furthermore, new onsets of uveitis have been reported during anti-TNF treatment of rheumatic diseases. Uveitis may occur de novo under anti-TNF therapy, mainly in spondyloarthropathies, but also in rheumatoid arthritis and juvenile idiopathic arthritis patients, and more frequently under etanercept [55,56]. Observational studies in daily practice strongly support the exposed outcomes [57].
Drug-Induced Uveitis: Part 1: Immune Checkpoint, B-Raf Proto-Oncogene, Mitogen-Activated Extracellular Signal-Regulated Kinase, and Tumor Necrosis Factor Inhibitors
2020, Advances in Ophthalmology and OptometryCitation Excerpt :The TNFi-associated uveitis is mainly acute nongranulomatous AU. According to a French retrospective analysis using a national registry database, the estimated prevalence of new-onset uveitis in patients treated with anti-TNFα therapy was 1% [7]. As mentioned previously, etanercept is the TNFi most commonly associated with uveitis (up to 73% of uveitis induced by TNFi), although it has a lower overall rate of serious adverse events [7,98,105].
The authors have no conflicts of interest to disclose.