Background A high percentage (30-40%) of patients with Ankylosing Spondylitis (AS) suffer from acute anterior uveitis (AAU) attacks. Local treatment with corticosteroids is a beneficial treatment. In addition, there are suggestions that TNF blocking agents also decrease the recurrence rate of AAU attacks. However, proper prospective studies investigating the effectiveness of anti-TNF treatment on the recurrence rate of AAU attacks in AS are lacking.
Objectives To examine whether the use of adalimumab decreases the frequency of attacks of AAU in patients with AS, who receive this treatment for their spinal disease activity.
Methods Consecutive Dutch AS patients, who were treated for at least 12 weeks with 40 mg of adalimumab every other week according to the international ASAS consensus statement, were enrolled. The number of attacks of AAU before and during adalimumab treatment was assessed by patient history and ophthalmological controls at baseline and yearly thereafter. Follow-up ended at January First, 2012, or at discontinuation of adalimumab treatment for any reason.
Results A total of 77 patients were enrolled. The majority, 67 patients (87%), were seen by the ophthalmologist at baseline and 44 (57%) patients had at least one follow-up visit with the ophthalmologist. Ophthalmological data of the other patients was retrieved from hospital charts obtained at the protocol visits to the research physician. Out of the 77 patients, 50 (65%) did not have any attacks of uveitis in the 2 years before (and during) treatment with adalimumab, 17 (22%) had uveitis before, but not during adalimumab treatment, and 10 (13%) had attacks of uveitis in the 2 years before and during treatment with adalimumab. No one developed uveitis for the first time during adalimumab treatment. Twenty-seven patients (35%) suffered from recurrent attacks of uveitis in the 2 years before start of adalimumab treatment, with a median of 2.0 uveitis attacks per year (IQR: 1.0-3.5). During follow-up, only 10 patients (13%) had attacks of uveitis with a median of 0.56 uveitis attacks per year (IQR 0.30-0.75). The median follow-up was 1.74 years (IQR: 0.80-2.57). This constitutes a 63% drop in the number of patients with uveitis attacks. Both the number of patients with uveitis after start of adalimumab and the number of uveitis attacks per year dropped significantly (p=0.000), in comparison with the 2 years before start of adalimumab treatment. Interestingly, even the patient with a very high number of attacks of AAU (12 attacks per year prior to adalimumab) was completely free of uveitis attacks after the start of adalimumab, during his entire 4.4 years of follow-up.
Conclusions A significant and substantial reduction of recurrence rate of attacks of acute anterior uveitis during adalimumab treatment was found, even in patients with a high recurrence rate of attacks. The majority (87%) of patients remained completely free of uveitis attacks for the entire follow-up period.
Disclosure of Interest C. van Denderen: None Declared, I. Visman: None Declared, M. Nurmohamed Consultant for: BMS, MSD, Roche, Abbott, Pfizer and UCB, Speakers Bureau: for BMS, MSD, Roche, Abbott, Pfizer and UCB, M. Suttorp-Schulten: None Declared, I. van der Horst-Bruinsma: None Declared