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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Med. | doi: 10.3389/fmed.2019.00104

Anti-TNF drugs for chronic uveitis in adults – a systematic review and meta-analysis of randomized controlled trials

 Inês C. Leal1,  Filipe B. Rodrigues2,  David C. Sousa1, Gonçalo Duarte2,  Vasco C. Romão1, Carlos M. Neves1, João Costa2 and  João E. Fonseca3*
  • 1Hospital de Santa Maria, Portugal
  • 2Faculdade de Medicina, Universidade de Lisboa, Portugal
  • 3Instituto de Medicina Molecular, Portugal

Background: We aimed to assess efficacy and safety of anti- 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. Parallel-designed randomised controlled trials, assessing any anti-TNF vs. placebo 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.
Results: A total of 1157 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: Non-Infectious Uveitis, Anti-TNF agent, Systematic review, infliximab, etanercept

Received: 14 Mar 2019; Accepted: 29 Apr 2019.

Edited by:

Dimitrios Vassilopoulos, Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Greece

Reviewed by:

Garifallia Sakellariou, Division of Rheumatology, University of Pavia, Italy
Katerina Chatzidionysiou, Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Greece  

Copyright: © 2019 Leal, Rodrigues, Sousa, Duarte, Romão, Neves, Costa and Fonseca. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. João E. Fonseca, Instituto de Medicina Molecular, Lisboa, Portugal, jecfonseca@gmail.com