POS0757 OCCURRENCE OF UVEITIS AND FLARES IN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS UPON TUMOUR NECROSIS FACTOR (TNF)- INHIBITORS
Authors: C. Baucks, A. Zimmer, T. Hospach, D. Windschall, K. Minden, F. Weller-Heinemann, I. Foeldvari, G. Horneff
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Associated uveitis is common among patients with juvenile idiopathic arthritis and carries a risk of long-term damage to the eye and vision [1]. Data out of clinical practice regarding the occurrence of uveitis during therapy are limited. <h3>Objectives:</h3> Comparison of the occurrence of uveitis and uveitis flares under therapy with three different TNF inhibitors using the BIKER-registry. <h3>Methods:</h3> Baseline demographic characteristics, clinical and laboratory conditions as well as the occurrence of uveitis and uveitis flares during therapy with either Etanercept, Adalimumab or Golimumab were compared. <h3>Results:</h3> 3315 JIA patients treated with one of the TNF inhibitors etanercept (n=2121), adalimumab (n=963 patients) or golimumab (n=231 patients) were analyzed for the occurrence of first uveitis or uveitis recurrence. The cohorts differed significantly regarding the distribution of JIA subtype (p&lt;0.0002), the rate of ANA-positive patients treated with etanercept was significantly lower than the ones treated with adalimumab or golimumab (57.8% vs 67.6%/66.5%, p&lt;0. 0001), there were significant differences in age at disease onset (etanercept-cohort patients oldest, 7.4 years vs 6.36/5.5 years adalimumab/golimumab; p&lt;0.0001), while age at therapy start was highest in the golimumab cohort, these patients were significantly older than in the etanercept cohort (12.63 vs 11.6, p=0.0001). The groups differed significantly regarding the CHAQ-DI (etanercept 0.65 vs 0.48/0.46 adalimumab/golimumab, p&lt;0.0001), the JADAS (etanercept 15.1 vs 11.2/11.1 adalimumab/golimumab, p&lt;0.0001), CRP and ESR (both significantly higher in the etanercept cohort than in the adalimumab/golimumab cohort, p=0.0001). Concomitant therapy with steroids was used significantly more often in the etanercept cohort than in the other two groups (33.4% vs. 24.4/16%, p&lt;0.0001), MTX was applied significantly less in the adalimumab cohort than in the etanercept and golimumab cohort (64% vs. 72% each, p&lt;0.0001). There were significant differences in pre-treatment with other biologics, in the etanercept cohort 5.6% of the patients were pre-treated with biologics, in the adalimumab cohort 58.3% and in the golimumab cohort 78.4% (p&lt;0.0001). Uveitis before start of treatment was significantly more frequent in the adalimumab and golimumab cohort than in the etanercept cohort (approx. 30% vs. 6.7%, p&lt;0.0001). Uveitis recurrence also differed significantly, occurring most often and earlier (Figure 1A) in the golimumab cohort in approximately 36% of patients with preexisting uveitis, while it was documented in approx. 23% upon adalimumab and in 19% upon etanercept (p=0.02). The rates were 30.5 vs. 10 vs 7.7 events/100PY in the golimumab vs adalimumab vs etanercept cohort (p&lt;0.0007). The first occurrence of uveitis during ongoing therapy did not differ significantly between the cohorts (Figure 1B). <h3>Conclusion:</h3> Pre-existing uveitis increases the risk of recurrence compared to the probability of developing first uveitis during treatment. Etanercept is used less frequently in patients with a preexisting uveitis. Adalimumab is often used as first-line biologic therapy for uveitis, so the rate of pre-existing uveitis in this group should be evaluated accordingly in the interpretation. Recurrence of uveitis is significantly more frequent with golimumab than with etanercept or adalimumab. While golimumab is used as a second-line or third-line biologic in almost 80% of cases; the previous treatment refractory status including uveitis of the patients is a bias which should be taken into account when evaluating the data. The results have to be interpreted carefully due to significant differences in baseline parameters. Observation is ongoing. <h3>REFERENCES:</h3> [1] Foeldvari I, Becker I, Horneff G. Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry. Arthritis Care Res (Hoboken). 2015 Nov;67(11):1529-35. doi: 10.1002/acr.22613. PMID: 25988824. <h3>Acknowledgements:</h3> This study would not have been possible without the collaboration of numerous German and Austrian paediatric rheumatologists, patients and their parents <h3>Disclosure of Interests:</h3> Carolin Baucks: None declared, Angela Zimmer: None declared, Toni Hospach: None declared, Daniel Windschall: None declared, Kirsten Minden: None declared, Frank Weller-Heinemann: None declared, Ivan Foeldvari: None declared, Gerd Horneff Pfizer Chugai, Novartis, MSD, Pfizer, Roche, MSD, Novartis.