To evaluate the effect of adalimumab around the frequency of anterior uveitis (AU) flares in patients with active ankylosing spondylitis (AS). with a recent history of AU flares. Clinical trials: ClinicalTrials.gov Identifier: NCT00478660. Tumour necrosis factor (TNF) antagonists are highly effective agents for the treatment of patients with active ankylosing spondylitis (AS). In addition to the spine the immunological inflammation of AS may also involve peripheral joints and extraskeletal structures such as the vision skin and bowel. Between 20% and 40% of patients with AS experience at least one flare of anterior Olanzapine (LY170053) uveitis (AU) at any time during the course of the disease.1 2 An attack of AU may even be the first symptom that leads to the diagnosis of AS.3 4 Underlying AS is diagnosed in up to 50% of patients Olanzapine (LY170053) with AU particularly in the presence of the human leukocyte antigen (HLA)-B27.5 The course of AU varies Olanzapine (LY170053) widely; patients may experience only one uveitis flare in a lifetime whereas others have recurrent episodes. Some patients also have chronic uveitis that is characterised by prolonged episodes of uveitis (defined as at least 3 months in duration) with a symptom-free interval of less than 3 months after treatment discontinuation.6 Among the traditional disease-modifying antirheumatic drugs (DMARDs) that are generally of dubious effect in patients with AS compared with patients with rheumatoid arthritis or with psoriatic arthritis a preventive effect of DMARDs on AU flares has been reported only for sulfasalazine.7 Acute or chronic episodes of AU particularly in children with juvenile inflammatory arthritis and uveitis have been successfully treated with infliximab whereas etanercept was mostly ineffective.1 8-16 The effect of TNF antagonists on AU in patients with spondyloarthritis (SpA) or AS was analysed in one large retrospective study and one meta-analysis of seven clinical trials four of which were placebo-controlled randomised trials.17 18 The retrospective Olanzapine (LY170053) study suggested that this TNF antagonists infliximab and adalimumab reduced the rate of AU flares whereas the frequency Rabbit polyclonal to INSL6. of AU flares in patients with SpA who were treated with etanercept remained unchanged.18 In the meta-analysis infliximab and etanercept therapies reduced the incidence of AU flares and infliximab appeared to be more effective than etanercept; adalimumab was not evaluated.17 By contrast new-onset uveitis was reported during TNF-antagonist therapy in patients with rheumatic disorders that are not commonly associated with uveitis. A review of the literature indicates that new-onset AU has been reported primarily during etanercept treatment rarely during infliximab treatment and not during adalimumab treatment.11 19-24 Questions of clinical interest include whether patients with AS and AU respond similarly to TNF antagonists compared with patients without a history of AU and whether there is a correlation between adalimumab effectiveness on AS and on prevention of AU flares. Here we statement analyses of data from your “Review of security and effectiveness witH Adalimumab in Patients with active ankylosing SpOnDYlitis” (RHAPSODY) trial. With 1250 patients enrolled this is the largest prospective clinical trial to evaluate the effect of adalimumab on AU flares in patients with AS to date. PATIENTS AND METHODS Patients Adults ?18 years of age with active AS according to the modified New York Criteria for Ankylosing Spondylitis 198425 and with a Bath AS Disease Activity Index26 (BASDAI) Olanzapine (LY170053) ?4 despite treatment with at least one nonsteroidal anti-inflammatory drug (NSAID) were enrolled. Olanzapine (LY170053) Previous treatment..