Abstract
Purpose :
To compare the hazard of age-related macular degeneration (AMD) in rheumatoid arthritis (RA) patients on TNF-α inhibitors to RA patients on methotrexate, the first-line therapy for RA.
Methods :
A retrospective cohort study was performed on data from 2010-2015 within a large US commercial insurance database, using a weighted Cox proportional hazards model of three groups: 1) methotrexate alone, 2) TNF-α inhibitor alone, and 3) TNF-α inhibitor and methotrexate. Inclusion criteria were a diagnosis of RA and age ≥ 50 years of age. Exclusion criteria were use of hydroxychloroquine, prior history of inherited retinal degeneration, or a prior diagnosis of AMD within a six-month lead-in time. Covariates included age, sex, and a propensity score consisting of the following: hypertension, smoking (COPD and chronic bronchitis used as surrogates), stroke, uveitis or scleritis, diabetes, coronary artery disease, history of colonoscopy, history of endoscopy, history of GI imaging series, peptic ulcer disease, chronic liver disease, hepatitis C, congestive heart failure, hyperlipidemia, cox-2 inhibitors, renal failure, obesity, osteoporosis and fractures, and intra-articular injections. The end point was any diagnosis of AMD.
Results :
Group 1 had 118,562 patients, group 2 had 10,711 patients, and group 3 had 18,657 patients. After controlling for age and sex, there was no significant difference in the hazard ratio in developing AMD between groups 1 and 2 (HR = 1.05, 95% CI 0.89-1.18, p = 0.39), or groups 1 and 3 (HR = 0.98, 95% CI 0.92-1.06, p = 0.66) or groups 2 and 3 (HR = 0.93, 95% CI 0.84-1.04, p = 0.20). A diagnosis of uveitis or scleritis in RA patients was the single largest risk factor for developing AMD (HR = 2.26, 95% CI 1.94-2.626, p < 0.00001). Stroke (HR = 1.49, 95% CI 1.35-1.65, p < 0.00001) and hypertension (HR = 1.44, 95% CI 1.32-1.57, p < 0.00001) were also strong risk factors.
Conclusions :
In this sample of patients with RA, immune modulation via TNF-α inhibition did not change the hazard of developing AMD. Interestingly, there was an increased hazard for developing AMD in patients with uveitis or scleritis. This further suggests that an aberrant immune response is implicated in AMD, though therapeutic targets of these pathways remain elusive.
This is a 2021 ARVO Annual Meeting abstract.