Comparative risk of incident and recurrent acute anterior uveitis across different biological agents in patients with ankylosing spondylitis

Abstract Objective To evaluate the comparative risk of incident and recurrent acute anterior uveitis (AAU) across different biological DMARDs (bDMARDs) in patients with AS. Methods A retrospective nationwide cohort study was conducted on 34 621 patients with AS without a previous history of AAU using a national claims database. Patients were followed-up from 2010 to 2021. The comparative risk of incident and recurrent AAU across different bDMARDs was examined using multivariable time-dependent Cox models and counting process (Anderson–Gill) models, respectively. Results The adjusted hazard ratios (aHRs) and 95% CIs for incident AAU (bDMARDs non-exposure as reference) were: adalimumab 0.674 (0.581–0.891), etanercept 1.760 (1.540–2.012), golimumab 0.771 (0.620–0.959), infliximab 0.891 (0.741–1.071) and secukinumab 1.324 (0.794–2.209). Compared with adalimumab exposure, etanercept [aHR 2.553 (2.114–3.083)], infliximab [aHR 1.303 (1.039–1.634)] and secukinumab [aHR 2.173 (1.273–3.710)] exposures showed a higher risk of incident AAU. The aHRs and 95% CIs for recurrent AAU (bDMARDs non-exposure as reference) were: adalimumab 0.798 (0.659–0.968), etanercept 1.416 (1.185–1.693), golimumab 0.874 (0.645–1.185), infliximab 0.926 (0.729–1.177) and secukinumab 1.257 (0.670–2.359). Compared with adalimumab exposure, etanercept exposure [aHR 1.793 (1.403–2.292)] was associated with a higher risk of recurrent AAU. Conclusion Our data suggest preference for bDMARDs in the following order: adalimumab/golimumab > infliximab > secukinumab > etanercept (for incident AAU prevention) and adalimumab > golimumab/infliximab/secukinumab > etanercept (for recurrent AAU prevention).