Certolizumab Pegol Reduced Anterior Uveitis Flares Compared With Standard Non-Biologic Treatment: Results From an Overlap Weighting Analysis in High-Risk Patients With Axial Spondyloarthritis

Objective: Acute anterior uveitis (AAU) is the most common extra-musculoskeletal manifestation of axial spondyloarthritis (axSpA). This study compared the effect of the tumor necrosis factor inhibitor (TNFi) certolizumab pegol (CZP) with standard non-biologic care, on AAU flare rate in patients with axSpA and high risk of recurrent uveitis flares. Methods: C-VIEW (NCT03020992) was an open-label, multicenter study in which patients with radiographic or non-radiographic axSpA and high risk of uveitis flares received CZP for 96 weeks. Here, AAU flare rate was compared between patients in C-VIEW (up to 120 weeks) and high-risk patients with axSpA receiving standard non-biologic treatment from the University of California, San Francisco (UCSF) and University Health Network Toronto Western Hospital (UHN). Overlap weighting (OW) was utilized to adjust for potential confounders, followed by Poisson regression to evaluate the effect of CZP on AAU flare rate. Results: Eighty-seven patients from C-VIEW were compared to 75 axSpA patients with comparative disease activity and not on biologic treatment (UCSF n = 40; UHN n = 35). After OW, there were no significant differences between groups in baseline characteristics included in the model. The AAU flare rate was significantly lower for patients treated with CZP than in the comparator population: after OW, a 70.9% lower AAU flare rate was associated with CZP treatment (risk ratio [95% confidence interval]: 0.29 [0.18, 0.47]; p < 0.001). Conclusion: This study supports the findings of C-VIEW and demonstrates the benefit of CZP over standard non-biologic treatment as a promising therapeutic option in reducing AAU flares among high-risk patients with axSpA.