Association between nonsteroidal anti-inflammatory drugs and uveitis recurrence in ankylosing spondylitis patients

Abstract

Purpose : Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy for ankylosing spondylitis (AS). AS patients may develop acute anterior uveitis. While some report that NSAIDs may be helpful in preventing uveitic flares, there is limited data overall on their potential impact. The aim of this study was to assess the impact of oral NSAIDs on uveitis recurrence in AS patients.

Methods : We utilized a prospective longitudinal AS cohort. Standardized questionnaires were collected at baseline and every 6 months to assess the status of AS and uveitis and collect all systemic and topical medications used. Fisher exact tests were used to compare categorical variables. Patients were included in our analysis if they had a history of uveitis at baseline or if they developed incident uveitis during their follow-up. Recurrence was defined as uveitis occurring after this initial designation. Incidence rate of uveitis was also calculated. A mixed-effects longitudinal logistic regression model was used to look at the association of NSAIDS on the recurrence of uveitis, weighted by the inverse propensity scores of using NSAIDS, which were adjusted for age at baseline, follow-up time, B27 positivity, use of disease-modifying anti-rheumatic drugs (DMARDs), etanercept and all other TNF inhibitors and other biologics.

Results : 1024 AS patients were enrolled between 3/23/2007 and 10/13/2016. 460 (45%) were using oral NSAIDs at baseline. 331 (32%) had a diagnosis of uveitis at baseline and 56 developed uveitis during follow-up, resulting in a 3.8% risk of developing uveitis per person-year. See Table 1 for other baseline information. The weighted adjusted regression model found that patients with a history of uveitis who were using NSAIDS had a 26% lower odds of having a uveitis recurrence (odds ratio 0.74, 95% CI 10.2 - 39.4, p = 0.003).

Conclusions : In AS patients with a history of uveitis, oral NSAID use was associated with lower odds of a uveitis recurrence. NSAIDs could be considered as a potential treatment for preventing uveitis flare-ups.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.