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Anterior uveitis in patients with spondyloarthritis treated with secukinumab or tumour necrosis factor inhibitors in routine care: does the choice of biological therapy matter?
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  • Published on:
    Correspondence on “Anterior uveitis in patients with spondyloarthritis treated with secukinumab or tumour necrosis factor inhibitors in routine care: does the choice of biological therapy matter?” by “Ulf Lindström et al”
    • Weijie Wang, doctor the Second Affiliated Hospital of Zhejiang Chinese Medical University
    • Other Contributors:
      • Yung-Heng Lee, doctor
      • Yi-Chiao Bai, doctor
      • James Cheng-Chung Wei, professor

    We have read with great interest the work of Ulf Lindström et al studying on comparing the risk of anterior uveitis (AU) in spondyloarthritis (SpA) during treatment with secukinumab versus tumour necrosis factor inhibitors (TNFi). They concluded that secukinumab appears to be associated with a higher risk of AU, compared with the monoclonal TNFi and a similar risk compared with etanercept1. However, we believe that some concerns should be discussed in this important study.

    First of all, the recruited SpA patients starting secukinumab or a TNFi between 1 Jan 2015 and 31 December 2018 were identified and the follow-up were most at the end of study 31 December 2018. However, there would be certain bias on the comparison of the rate of AU-diagnoses between the patients during treatment with secukinumab or TNFi in the late 2018 to the patients during treatment with TNFi or secukinumab in the early 2015. It would be more proper to adjust the treatment starting time. Furthermore, subgroups for the different starting year were also recommended to analyze.

    Secondly, conventional synthetic DMARDs, such as methotrexate (MTX) and sulfasalazine (SSZ), were sometimes used together with secukinumab or a TNFi in part of the patients. For both SSZ and MTX, a reduction in the AAU flare rate and sight-threatening complications has been reported especially on the course of HLA-B27-positive anterior uveitis2-4. AS a result, concomitant csDMARDs with secukinumab or a TNFi could be...

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    Conflict of Interest:
    None declared.