Risk of Acute Anterior Uveitis in Ankylosing Spondylitis According to the Type of Tumor Necrosis Factor-Alpha Inhibitor and History of Uveitis: A Nationwide Population-Based Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Procedures and Outcomes
2.3. Statistical Analysis
3. Results
3.1. Study Population
3.2. The Risk of AAU According to the Type of TNFis
3.3. Incidence of All AAU Events within 2 Years after the Initiation of TNF Inhibitors
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (n = 5938) | ADA (n = 2477) | ETN (n = 1218) | IFX (n = 1214) | GOL (n = 1029) | p-Value | |
---|---|---|---|---|---|---|
Treatment duration, year | 4.7 ± 2.2 | 4.8 ± 2.3 | 4.8 ± 2.3 | 5.3 ± 2.3 | 3.6 ± 1.3 | <0.001 |
Age, year | 37.2 ± 13.1 | 36.8 ± 13.2 | 37.6 ± 14.8 | 37.0 ± 13.1 | 38.0 ± 13.6 | 0.083 |
Age group, year | 0.143 | |||||
<30 | 1983 (33.4) | 839 (33.9) | 409 (33.6) | 405 (33.4) | 330 (32.1) | |
30–39 | 1537 (25.9) | 654 (26.4) | 286 (23.5) | 325 (26.8) | 272 (26.4) | |
40–49 | 1239 (20.9) | 522 (21.1) | 254 (20.9) | 251 (20.7) | 212 (20.6) | |
50–59 | 793 (13.4) | 326 (13.2) | 170 (14.0) | 161 (13.3) | 136 (13.2) | |
60< | 386 (6.5) | 136 (5.5) | 99 (8.2) | 72 (5.9) | 79 (7.6) | |
Sex | 0.041 | |||||
Male | 4610 (77.6) | 1959 (79.1) | 953 (78.2) | 915 (75.4) | 783 (76.1) | |
Female | 1328 (22.4) | 518 (20.9) | 265 (21.8) | 299 (24.6) | 246 (23.9) | |
Previous AAU history | 1488 (25.1) | 692 (27.9) | 269 (22.1) | 304 (25.0) | 223 (21.7) | <0.001 |
Charlson comorbidity index | 0.53 ± 0.97 | 0.52 ± 0.93 | 0.61 ± 1.11 | 0.47 ± 0.84 | 0.57 ± 1.04 | 0.002 |
0 | 3939 (66.3) | 1648 (66.5) | 786 (64.5) | 825 (68.0) | 680 (66.1) | 0.001 |
1 to 2 | 1734 (29.2) | 730 (29.5) | 363 (29.8) | 356 (29.3) | 285 (27.7) | |
3 to 4 | 265 (4.5) | 99 (4.0) | 69 (5.7) | 33 (2.7) | 64 (6.2) | |
Comorbidities (1 year prior to index date) | ||||||
Dyslipidemia | 756 (12.7) | 307 (12.4) | 170 (14.0) | 154 (12.7) | 125 (12.1) | 0.528 |
Hypertension | 702 (11.8) | 298 (12.0) | 145 (11.9) | 132 (10.9) | 127 (12.3) | 0.699 |
Diabetes mellitus | 305 (5.1) | 127 (5.1) | 72 (5.9) | 53 (4.4) | 53 (5.2) | 0.394 |
COPD | 226 (3.8) | 94 (3.8) | 55 (4.5) | 41 (3.4) | 36 (3.5) | 0.466 |
Ischemic heart disease | 118 (2.0) | 54 (2.2) | 27 (2.2) | 18 (1.5) | 19 (1.8) | 0.477 |
Psoriasis | 61 (1.0) | 26 (1.0) | 9 (0.7) | 14 (1.2) | 12 (1.2) | 0.707 |
Stroke | 47 (0.8) | 19 (0.8) | 14 (1.1) | 6 (0.5) | 8 (0.8) | 0.337 |
Renal failure | 25 (0.4) | 7 (0.3) | 10 (0.8) | 1 (0.1) | 7 (0.7) | 0.013 |
Asthma | 21 (0.4) | 10 (0.4) | 7 (0.6) | 0 (0.0) | 4 (0.4) | 0.102 |
Total (n = 5938) | ADA (n = 2477) | ETN (n = 1218) | IFX (n = 1214) | GOL (n = 1029) | p-Value | |
---|---|---|---|---|---|---|
Use of corticosteroid (≥90 days) | 2993 (50.4) | 1254 (50.6) | 611 (50.2) | 668 (55.0) | 460 (44.7) | <0.001 |
Use of NSAIDs (≥0.7 PDC) | 2424 (40.8) | 939 (37.9) | 533 (43.8) | 535 (44.1) | 417 (40.5) | <0.001 |
Immune modulating agents | 5117 (86.2) | 2214 (89.4) | 1016 (83.4) | 1082 (89.1) | 805 (78.2) | <0.001 |
Sulfasalazine | 4792 (80.7) | 2082 (84.1) | 934 (76.7) | 1011 (83.3) | 765 (74.3) | <0.001 |
Methotrexate | 1998 (33.6) | 872 (35.2) | 422 (34.6) | 449 (37.0) | 255 (24.8) | <0.001 |
Cyclosporine | 192 (3.2) | 83 (3.4) | 34 (2.8) | 45 (3.7) | 30 (2.9) | 0.558 |
Azathioprine | 84 (1.4) | 26 (1.0) | 16 (1.3) | 35 (2.9) | 7 (0.7) | <0.001 |
Mycophenolate mofetil | 12 (0.2) | 6 (0.2) | 1 (0.1) | 5 (0.4) | 0 (0.0) | 0.122 |
Cyclophosphamide | 2 (0.0) | 0 (0.0) | 0 (0.0) | 2 (0.2) | 0 (0.0) | 0.051 |
Total | AAU Cases | Sum of py | IR (/100 py) | 95% CI | HR | 95% CI | p-Value | aHR * | 95% CI | p-Value | |
---|---|---|---|---|---|---|---|---|---|---|---|
Total | 5938 | 609 | 11203 | 5.4 | 5.0–5.9 | ||||||
Adalimumab | 2477 | 226 | 4696 | 4.8 | 4.2–5.5 | Ref | Ref | ||||
Etanercept | 1218 | 188 | 2232 | 8.4 | 7.3–9.7 | 1.75 | 1.44–2.12 | <0.001 | 1.77 | 1.46–2.14 | <0.001 |
Infliximab | 1214 | 105 | 2312 | 4.5 | 3.7–5.5 | 0.94 | 0.75–1.19 | 0.620 | 0.92 | 0.73–1.16 | 0.495 |
Golimumab | 1029 | 90 | 1962 | 4.6 | 3.7–5.6 | 0.95 | 0.75–1.22 | 0.698 | 0.98 | 0.76–1.25 | 0.846 |
AAU history (+) | 1488 | 448 | 2469 | 18.1 | 16.5–19.9 | ||||||
Adalimumab | 692 | 182 | 1170 | 15.6 | 13.4–18.0 | Ref | Ref | ||||
Etanercept | 269 | 124 | 398 | 31.2 | 25.9–37.2 | 1.99 | 1.58–2.50 | <0.001 | 1.99 | 1.58–2.50 | <0.001 |
Infliximab | 304 | 80 | 523 | 15.3 | 12.1–19.0 | 0.98 | 0.75–1.27 | 0.876 | 0.97 | 0.74–1.26 | 0.807 |
Golimumab | 223 | 62 | 379 | 16.4 | 12.6–21.0 | 1.05 | 0.79–1.40 | 0.739 | 1.07 | 0.80–1.43 | 0.647 |
AAU history (−) | 4450 | 161 | 8733 | 1.8 | 1.6–2.2 | ||||||
Adalimumab | 1785 | 44 | 3526 | 1.2 | 0.9–1.7 | Ref | Ref | ||||
Etanercept | 949 | 64 | 1834 | 3.5 | 2.7–4.5 | 2.80 | 1.91–4.11 | <0.001 | 2.82 | 1.92–4.13 | <0.001 |
Infliximab | 910 | 25 | 1789 | 1.4 | 0.9–2.1 | 1.12 | 0.69–1.83 | 0.651 | 1.10 | 0.67–1.79 | 0.709 |
Golimumab | 806 | 28 | 1584 | 1.8 | 1.2–2.6 | 1.42 | 0.88–2.28 | 0.150 | 1.45 | 0.90–2.32 | 0.128 |
AAU Cases | Sum of py | IR (/100 py) | 95% CI | IRR | 95% CI | p-Value | IRR * | 95% CI | p-Value | |
---|---|---|---|---|---|---|---|---|---|---|
Total | ||||||||||
Adalimumab | 389 | 5612 | 6.8 | 5.9–7.8 | Ref | Ref | ||||
Etanercept | 355 | 2760 | 12.4 | 10.7–14.3 | 1.82 | 1.49–2.22 | <0.001 | 1.78 | 1.46–2.18 | <0.001 |
Infliximab | 168 | 2620 | 6.2 | 5.0–7.6 | 0.91 | 0.70–1.17 | 0.456 | 0.92 | 0.72–1.18 | 0.525 |
Golimumab | 145 | 2232 | 6.5 | 5.3–8.0 | 0.96 | 0.75–1.22 | 0.712 | 0.92 | 0.72–1.18 | 0.512 |
AAU history (+) | ||||||||||
Adalimumab | 313 | 1549 | 19.9 | 17.2–22.9 | Ref | Ref | ||||
Etanercept | 230 | 602 | 37.6 | 32.5–43.6 | 1.89 | 1.54–2.33 | <0.001 | 1.86 | 1.51–2.29 | <0.001 |
Infliximab | 132 | 652 | 19.8 | 16.0–24.5 | 1.00 | 0.77–1.29 | 0.985 | 1.00 | 0.78–1.30 | 0.986 |
Golimumab | 106 | 488 | 21.4 | 17.2–26.8 | 1.08 | 0.83–1.40 | 0.568 | 1.05 | 0.81–1.36 | 0.702 |
AAU history (−) | ||||||||||
Adalimumab | 76 | 4063 | 1.9 | 1.4–2.5 | Ref | Ref | ||||
Etanercept | 125 | 2159 | 5.5 | 4.3–7.1 | 2.98 | 2.04–4.37 | <0.001 | 2.92 | 2.00–4.26 | <0.001 |
Infliximab | 36 | 1969 | 1.8 | 1.2–2.6 | 0.95 | 0.57–1.58 | 0.852 | 0.97 | 0.59–1.60 | 0.920 |
Golimumab | 39 | 1745 | 2.3 | 1.6–3.3 | 1.22 | 0.76–1.95 | 0.417 | 1.16 | 0.72–1.87 | 0.554 |
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Ahn, S.M.; Kim, M.; Kim, Y.-J.; Lee, Y.; Kim, Y.-G. Risk of Acute Anterior Uveitis in Ankylosing Spondylitis According to the Type of Tumor Necrosis Factor-Alpha Inhibitor and History of Uveitis: A Nationwide Population-Based Study. J. Clin. Med. 2022, 11, 631. https://doi.org/10.3390/jcm11030631
Ahn SM, Kim M, Kim Y-J, Lee Y, Kim Y-G. Risk of Acute Anterior Uveitis in Ankylosing Spondylitis According to the Type of Tumor Necrosis Factor-Alpha Inhibitor and History of Uveitis: A Nationwide Population-Based Study. Journal of Clinical Medicine. 2022; 11(3):631. https://doi.org/10.3390/jcm11030631
Chicago/Turabian StyleAhn, Soo Min, Minju Kim, Ye-Jee Kim, Yusun Lee, and Yong-Gil Kim. 2022. "Risk of Acute Anterior Uveitis in Ankylosing Spondylitis According to the Type of Tumor Necrosis Factor-Alpha Inhibitor and History of Uveitis: A Nationwide Population-Based Study" Journal of Clinical Medicine 11, no. 3: 631. https://doi.org/10.3390/jcm11030631
APA StyleAhn, S. M., Kim, M., Kim, Y. -J., Lee, Y., & Kim, Y. -G. (2022). Risk of Acute Anterior Uveitis in Ankylosing Spondylitis According to the Type of Tumor Necrosis Factor-Alpha Inhibitor and History of Uveitis: A Nationwide Population-Based Study. Journal of Clinical Medicine, 11(3), 631. https://doi.org/10.3390/jcm11030631