Comparative Efficacy and Safety of Adalimumab and Infliximab for Treatment of Non-Infectious Uveitis: A Systematic Review and Meta-Analysis
Authors:Felicia Tai, Parsa Mehraban Far, Lauren Ramsay, Petros Pechlivanoglou, Kaitlin Fuller, Kira Dyzulnsky, Jorge Georgakopoulos, Beate Sander, Larissa Derzko-Dyzulnsky, Tina Felfeli.
Disclosure Block:
F. Tai: None. P. Mehraban Far: None. L. Ramsay: None. P. Pechlivanoglou: None. K. Fuller: None. K. Dyzulnsky: None. J. Georgakopoulos: None. B. Sander: None. L. Derzko-Dyzulnsky: None. T. Felfeli: None.
Abstract Title:
Comparative Efficacy and Safety of Adalimumab and Infliximab for Treatment of Non-Infectious Uveitis: A Systematic Review and Meta-Analysis
Abstract Body:
Purpose: Uveitis is one of the leading causes of preventable blindness in Western countries, with non-infectious uveitis (NIU) being more prevalent than infectious uveitis. Tumor necrosis factor-α inhibitors (anti-TNFα) are commonly used biologic agents for systemic treatment of uveitis after failure of first line agents and for the corticosteroid-sparing effect. The evidence comparing the two most commonly used biologics, Adalimumab (Humira, ADA) and infliximab (Remicade, IFX) is conflicting. This study aims to evaluate the comparative efficacy and safety of ADA and IFX.
Study Design: Systematic review and meta-analysis as per PRISMA guidelines (PROSPERO: CRD42020203049).
Methods: A sensitive search of MEDLINE, EMBASE, SCOPUS, clinicaltrials.gov, clinicaltrialsregistry.eu, CENTRAL, and WHO ICTRP databases from inception until August 2020 was conducted. Randomized controlled trials, observational studies, retrospective studies, case series of ≥5 patients, and abstracts on ADA or IFX for NIU in adults were included. Risk of bias assessment was done with Joanna Briggs Institute Critical Appraisal Tools. Primary efficacy and safety outcomes were logMAR best corrected visual acuity (BCVA) and discontinuation rate due to adverse events (AEs), respectively. Additional efficacy outcomes included corticosteroid-sparing effect, central macular thickness (CMT), and remission rate. Meta-analysis was performed using random-effects model to estimate Mantel-Haenszel risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes at 95% confidence intervals (CI) using RevMan 5.4.
Results: A total of 5154 unique studies were screened, 13 of which met the inclusion criteria (IFX: n=417 eyes; ADA: n=349 eyes). The following efficacy outcomes showed no significant difference: BCVA (MD=0.05, CI: [-0.26, 0.37]), corticosteroid-sparing effect (MD=0.84, CI: [-1.02, 2.70]), and remission rate (RR=0.83, CI: [0.64, 1.08]). CMT MD= -12.37 (95% CI [-22.73, -2.00], I2=0%, p=0.02) significantly favoured ADA over IFX. Discontinuation rate due to AEs were relatively lower for ADA compared to IFX (RR=0.62; 95% CI [0.42, 0.92], I2=0%, p=0.02). Of the patients with one or more reported AEs, infection (20%), neoplasm (12%), arthralgia (8%) and allergic reactions (8%) were the most common for ADA, while hypersensitivity reaction (16%), infections (16%; pulmonary, tuberculosis, sepsis), and headaches (14%) were most common for IFX.
Conclusions: Evidence in the literature regarding comparative ADA and IFX efficacy and safety is sparse. Efficacy was found to be similar between the two drugs, but ADA may potentially have slightly better safety outcomes than IFX in the treatment of NIU based on lower discontinuation rates due to AEs.
