Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 24:6:104.
doi: 10.3389/fmed.2019.00104. eCollection 2019.

Anti-TNF Drugs for Chronic Uveitis in Adults-A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Inês Leal  1   2 , Filipe B Rodrigues  3   4 , David Cordeiro Sousa  1   2 , Gonçalo S Duarte  3   4 , Vasco C Romão  5   6 , Carlos Marques-Neves  1   2 , João Costa  3   4   7   8 , João Eurico Fonseca  5   6
Affiliations

Anti-TNF Drugs for Chronic Uveitis in Adults-A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Inês Leal et al. Front Med (Lausanne). .

Abstract

Background: We aimed to assess efficacy and safety of anti-tumor necrosis factor (TNF) drugs for adult chronic non-infectious uveitis (NIU). Methods: CENTRAL, MEDLINE, and EMBASE, were searched from inception to January 2019. Double-masked randomized placebo-controlled trials, assessing any anti-TNF vs. best medical intervention/standard of care in adults with chronic NIU were considered. The PRISMA and SAMPL guidelines were followed. The risk of bias was assessed using the Cochrane risk of bias tool. Overall quality of the evidence was assessed according to GRADE. PROSPERO registration: #CRD42016039068. The primary efficacy and safety outcomes were preservation of visual acuity (VA) and withdrawals due to adverse events, respectively. Meta-analysis of efficacy analysis was not performed due to significant clinical heterogeneity between studies' population and interventions. Results: A total of 1,157 references were considered and 3 studies were included. The overall risk of bias was moderate. In active NIU, adalimumab group showed an increased likelihood of VA preservation (risk ratio (RR) 1.75, 95%CI 1.32 to 2.32, n = 217), whereas the etanercept group did not (RR 0.81, 95%CI 0.57 to 1.14, n = 20). In inactive NIU, adalimumab was associated with increased likelihood of VA preservation (RR 1.31, 95%CI 1.12 to 1.53, n = 226). The rate of adverse events did not differ between anti-TNF and control arms (RR 1.03, 95%CI 0.94 to 1.13, n = 410). Conclusions: There is high quality evidence that adalimumab decreases the risk of worsening VA in active and inactive NIU and very low quality evidence that the risk of etanercept worsening VA in inactive NIU is not different from placebo. Moderate quality evidence suggests that anti-TNF agents are not different from placebo on the risk of study withdrawal.

Keywords: adalimumab; anti-tumor necrosis factor drugs; efficacy; etanercept; non-infectious uveitis; safety.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram.
Figure 2
Figure 2
Forest plot. (A) Rate of adverse events between the anti-TNF and control arms. (B) Rate of serious adverse events between the anti-TNF and control arms. (C) Risk of withdrawing between the anti-TNF and control arms.
Figure 3
Figure 3
Risk of bias summary.
See this image and copyright information in PMC

References

    1. Cordero-Coma M, Sobrin L. Anti-tumor necrosis factor-α therapy in uveitis. Surv Ophthalmol. (2015) 60:575–89. 10.1016/j.survophthal.2015.06.004 - DOI - PubMed
    1. Arcinue CA, Saboo US, Foster CS. Corticosteroids in uveitis. Nanomed. (2012) 2:55–64.
    1. Gritz DC, Wong IG. Incidence and prevalence of uveitis in Northern California: the Northern California Epidemiology of Uveitis Study. Ophthalmology. (2004) 111:491–500. 10.1016/j.ophtha.2003.06.014 - DOI - PubMed
    1. Thorne JE, Suhler E, Skup M, Tari S, Macaulay D, Chao J, et al. Prevalence of noninfectious uveitis in the United States. JAMA Ophthalmol. (2016) 21287:1–8. 10.1001/jamaophthalmol.2016.3229 - DOI - PubMed
    1. Srivastava A, Rajappa M, Kaur J. Uveitis: mechanisms and recent advances in therapy. Clin Chim Acta. (2010) 411:1165–71. 10.1016/j.cca.2010.04.017 - DOI - PubMed

Publication types

LinkOut - more resources