Objectives This study compared the incidence and time-to-event outcomes of ocular extraintestinal manifestations (O-EIMs) and EIMs among patients with human leukocyte antigen (HLA)-B27-associated diseases receiving different classes of immunotherapy. Methods A retrospective cohort study was conducted using aggregated electronic health records from the TriNetX network between January 1, 2014, and December 31, 2024. Patients with HLA-B27-associated diseases were included if they were newly prescribed tumor necrosis factor (TNF), janus kinase (JAK), or interleukin (IL) inhibitors on or after their initial diagnosis. The cumulative incidence of O-EIMs and EIMs was calculated per 100 person-years. Kaplan–Meier estimates were used to graph time-to-event outcomes using R Studio (version 4.4.1). Results We identified 22,287 patients [mean age 47.2 (16.8) years; 13,132 (58.9) % women]. The cumulative incidence of anterior uveitis from the index date was 0.11 cases per 100 person-years. According to first medication prescribed, the incidence of anterior uveitis was lowest in patients prescribed IL inhibitors, followed by JAK and TNF inhibitors (0.07%, 0.10%, and 0.20%, cases per 100 person-years respectively). Time-to-event analysis showed a higher likelihood of anterior uveitis with initial TNF inhibitor use, although the difference was not statistically significant. Regarding EIMs, incident sacroiliitis was highest with TNF (0.91%), followed by JAK (0.72%) and IL (0.37%). Psoriatic dermatitis incidence was highest with JAK inhibitors (2.85%), compared to TNF (2.19%) and IL (2.17%). Conclusion In this cohort study of patients with HLA-B27-associated diseases, the lack of statistical significance indicates similar effectiveness across immunotherapy classes in preventing O-EIMs and EIMs. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • Large-scale comparative study assessing time-to-incident O-EIMs and EIMs in patients with HLA-B27-associated diseases treated with TNF, JAK, or IL inhibitor therapies using real-world data from the TriNetX network. • Low overall incidence of O-EIMs and EIMs was observed across all immunotherapy classes, with no statistically significant difference in time-to-event outcomes, indicating similar effectiveness in preventing these manifestations. </entry> </row> </tbody> </tgroup> </Table>

Time to incident ocular and extraintestinal manifestation in HLA-B27-Associated diseases: a comparative study of immunotherapies

期刊论文
发表日期：

2025年9月4日

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Negin Yavari,
Karen M. Wai,
Amer F. Alsoudi,
Euna Koo,
Chase A. Ludwig,
Andrea L. Kossler,
Quan Dong Nguyen,
Prithvi Mruthyunjaya,
Ehsan Rahimy

摘要

Objectives

This study compared the incidence and time-to-event outcomes of ocular extraintestinal manifestations (O-EIMs) and EIMs among patients with human leukocyte antigen (HLA)-B27-associated diseases receiving different classes of immunotherapy.

Methods

A retrospective cohort study was conducted using aggregated electronic health records from the TriNetX network between January 1, 2014, and December 31, 2024. Patients with HLA-B27-associated diseases were included if they were newly prescribed tumor necrosis factor (TNF), janus kinase (JAK), or interleukin (IL) inhibitors on or after their initial diagnosis. The cumulative incidence of O-EIMs and EIMs was calculated per 100 person-years. Kaplan–Meier estimates were used to graph time-to-event outcomes using R Studio (version 4.4.1).

Results

We identified 22,287 patients [mean age 47.2 (16.8) years; 13,132 (58.9) % women]. The cumulative incidence of anterior uveitis from the index date was 0.11 cases per 100 person-years. According to first medication prescribed, the incidence of anterior uveitis was lowest in patients prescribed IL inhibitors, followed by JAK and TNF inhibitors (0.07%, 0.10%, and 0.20%, cases per 100 person-years respectively). Time-to-event analysis showed a higher likelihood of anterior uveitis with initial TNF inhibitor use, although the difference was not statistically significant. Regarding EIMs, incident sacroiliitis was highest with TNF (0.91%), followed by JAK (0.72%) and IL (0.37%). Psoriatic dermatitis incidence was highest with JAK inhibitors (2.85%), compared to TNF (2.19%) and IL (2.17%).

Conclusion

In this cohort study of patients with HLA-B27-associated diseases, the lack of statistical significance indicates similar effectiveness across immunotherapy classes in preventing O-EIMs and EIMs.

Key Points

• Large-scale comparative study assessing time-to-incident O-EIMs and EIMs in patients with HLA-B27-associated diseases treated with TNF, JAK, or IL inhibitor therapies using real-world data from the TriNetX network.

• Low overall incidence of O-EIMs and EIMs was observed across all immunotherapy classes, with no statistically significant difference in time-to-event outcomes, indicating similar effectiveness in preventing these manifestations.