Background/Purpose: Acute anterior uveitis (AAU) is the most common extra-articular manifestation in axial spondyloarthritis (axSpA), affecting up to 40% of patients and causing significant burden.¹ Previous studies have shown that tumor necrosis factor inhibitors (TNFi) can reduce the incidence of AAU flares in patients with radiographic axSpA (ankylosing spondylitis),^2-4 but few have focused on patients across the full axSpA spectrum. We report 2-year outcomes from the phase 4, open-label C‑VIEW study (NCT03020992), which investigated the impact of certolizumab pegol (CZP) treatment on AAU in patients with active axSpA and a recent history of AAU.

Methods: C-VIEW prospectively investigated patients with active axSpA who were HLA-B27 positive and had recurrent AAU, with a history of ≥1 AAU flare in the year prior to baseline (additional study criteria and study design are described elsewhere⁵). The primary efficacy variable was the incidence of AAU flares during 96 weeks of CZP treatment versus the 2-year pre-baseline period. AAU incidence was evaluated using Poisson regression adjusted for duration of time in each period, with period (pre- and post-baseline) and axSpA disease duration as covariates. Secondary efficacy variables were Assessment of SpondyloArthritis international Society 20%/40% (ASAS20/40) response rates, as well as mean Ankylosing Spondylitis Disease Activity Score (ASDAS) and mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) to Week 96.

Results: Of 115 enrolled patients, 89 initiated CZP treatment; 83 completed Week 96. The primary analysis revealed an 82% reduction in the incidence of AAU flares during CZP treatment compared with pre-baseline (Figure 1; rate ratio [95% CI]: 0.18 [0.12, 0.28], p< 0.001). The percentage of patients experiencing ≥1 and ≥2 AAU flares reduced from 100% and 59.6% pre-baseline to 20.2% and 11.2% during treatment. There were also improvements in axSpA disease activity (Figure 2): by Week 96, 75.6% and 58.5% of patients had achieved ASAS20 and ASAS40 responses, respectively. ASDAS and BASDAI also improved substantially over the 96-week treatment period. No new safety signal was identified, compared to previous reports.⁵

Conclusion: These data support the use of CZP for the treatment of patients with axSpA and a history of recurrent AAU. During 96 weeks’ CZP treatment, there was a significant reduction of 82% in the AAU flare rate compared to pre-baseline. There were also substantial improvements in patients’ axSpA disease activity.

References: 1. Martin TM. Curr Opin Rheumatol 2002;14:337–41; 2. van der Heijde D. Rheumatology (Oxford) 2017;56:1498–1509; 3. van Bentum RE. J Rheumatol 2019;46:153–9; 4. van Denderen JC. J Rheumatol 2014;41:1843–8; 5. van der Horst-Bruinsma I. RMD Open 2020;6:e001161.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reduction-of-anterior-uveitis-flares-in-patients-with-axial-spondyloarthritis-during-certolizumab-pegol-treatment-96-week-results-from-the-c-view-study/