Background Acute anterior uveitis (AAU) is common in ankylosing spondylitis (AS) (1). Golimumab, a tumor necrosis factor alpha (TNF-α) blocker, has proven to be effective in the treatment of AS (2). We have shown earlier that treatment with adalimumab, another TNF-α blocker, leads to a significant decrease in the recurrence rate of AAU (3) in AS. At present, the effect of golimumab on the recurrence rate of AAU in AS is unknown.
Objectives To investigate the effect of golimumab treatment on the recurrence rate of AAU attacks in AS patients.
Methods Consecutive AS patients were enrolled who all fulfilled the 1984 Modified New York criteria, and fulfilled the criteria for initiating treatment with a TNF-α blocker in the Netherlands. All patients were treated with golimumab 50mg once a month for 12 months. During treatment, all occurring AAU attacks were assessed. The historic presence of AAU attacks was assessed from the year before baseline for non-biological treated patients, or the year before the first treatment with a TNF-α blocker in case of a switch from another TNF-α blocker to golimumab. Disease activity was measured with the Ankylosing Spondylitis Disease Activity Score – C-reactive protein (ASDAS). Response to treatment was assessed with the ASAS-20.
Results In total, 93 patients (65% male) were evaluable as per protocol, with a mean age of 44±13 years and a median disease duration of 7 (0–53) years. Fifty-one patients (55%) were TNF-α blocker naive. Median ASDAS score at baseline was 3.1 (0.7–5.5), which decreased to 1.9 (0.1–5.1) at 12 months. ASAS-20 response was achieved by 36% of patients at month three (p<0.001), and by 49% of patients at month twelve (p<0.001).
Six patients (7%) had a prior history of AAU with a total of nine attacks in the year prior to the first TNF-α blocker use (9.8/100 patient years). During golimumab treatment, the rate of recurring AAU attacks was reduced to two new attacks (2.2/100 patient years), a significant reduction of 78% (p<0.001). These two AAU attacks occurred in two separate patients, of whom one had no history of AAU.
Conclusions Treatment of AS patients with golimumab leads to a significant decrease in disease activity. Simultaneously, the rate of recurring AAU attacks decreased significantly during golimumab treatment.
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Inman RD, Davis JC, Jr., Heijde D, Diekman L, Sieper J, Kim SI, et al. Efficacy and safety of golimumab in patients with ankylosing spondylitis: results of a randomized, double-blind, placebo-controlled, phase III trial. Arthritis Rheum 2008 Nov;58(11):3402–12.
Van Denderen JC, Visman IM, Nurmohamed MT, Suttorp-Schulten MS, van der Horst-Bruinsma IE. Adalimumab significantly reduces the recurrence rate of anterior uveitis in patients with ankylosing spondylitis. J Rheumatol 2014 Sep;41(9):1843–8.
Disclosure of Interest S. Heslinga: None declared, M. Nurmohamed: None declared, A. Gerards: None declared, E. Griep: None declared, C. Koehorst: None declared, M. Kok: None declared, A. Schilder: None declared, M. Verhoef Employee of: Merck Sharp & Dohme the Netherlands, a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA., I. Van der Horst-Bruinsma Grant/research support from: This study was funded by Merck Sharp & Dohme the Netherlands, a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.