Risk of new-onset and recurrent uveitis with different biologics for ankylosing spondylitis: a network meta-analysis.
Systematic Review
Uveitis is a common extra-articular manifestation of ankylosing spondylitis (AS), and a systematic analysis of the effects of biologics on new-onset and recurrent uveitis is clinically important./r/nWe conducted a network meta-analysis (NMA) to assess the impact of anti-TNF-α (adalimumab, etanercept, golimumab, and infliximab), IL-17 inhibitors (secukinumab, bimekizumab, and ixekizumab), and JAK inhibitors (tofacitinib and upadacitinib) on new-onset and recurrent uveitis. Phase II/III double-blind randomized controlled trials and cohort studies were included. The relative risk (RR) was estimated, and drug efficacy was ranked based on the surface under the cumulative ranking curve (SUCRA)./r/nA total of 17 articles with 18 studies and 11,529 AS patients were included. For new-onset uveitis, adalimumab reduced the risk significantly compared to etanercept and golimumab (RR: 0.30, 0.61), while etanercept increased the risk compared to golimumab and infliximab (RR: 2.03, 2.47). The SUCRA demonstrated that upadacitinib (84.0%) exhibited better efficacy, while ixekizumab (8.7%) was less effective than placebo (29.9%). For recurrent uveitis, adalimumab significantly reduced the risk compared to etanercept (RR: 0.70), while etanercept increased the risk compared to golimumab and infliximab (RR: 1.37, 1.70). Bimekizumab 160 mg and 320 mg were the most efficacious (SUCRA: 83.9%, 83.5%). A comprehensive analysis revealed that bimekizumab 320 mg and 160 mg were the most effective in reducing the incidence of uveitis. Ixekizumab and secukinumab were less effective than placebo./r/nJAK inhibitors were more effective for new-onset uveitis in AS patients. Inhibition of IL-17A (secukinumab and ixekizumab) alone might increase the risk of uveitis, while simultaneous inhibition of IL-17A and IL-17F (bimekizumab) significantly reduced the risk. Etanercept increased the risk of uveitis compared to other TNF-α inhibitors.
