Current and Emerging Therapies for Uveitis in Axial Spondyloarthritis: A Scoping Review

Uveitis is a common and potentially vision-threatening extra-musculoskeletal manifestation of axial spondyloarthritis (axSpA). Various biologic (bDMARD), as well as targeted synthetic (tsDMARD) disease-modifying anti-rheumatic drugs are established treatment options not only for axSpA, but for the whole spectrum of Spondyloarthritides. However, evidence from randomised-controlled trials (RCTs) specifically designed to assess axSpA-related uveitis treatment efficacy remains scarce, with the majority of evidence being extrapolated from RCTs with musculoskeletal orientation. This review examines current and emerging treatment options for axSpA-related uveitis, emphasising existing evidence gaps and clinical uncertainties.

A scoping literature review was conducted following the PRISMA guidelines. PubMed, Scopus, and Cochrane databases were searched, according to the prespecified protocol criteria. After inaugural screening, eligible studies were evaluated performing quality assessment for final inclusion.

55 studies were retrieved and finally included. Studies were published between 2002-2025. Uveitis exposure-adjusted incidence rates per 100 patient years (EAIR/100PY) ranged between 0-4.5 for tumour necrosis factor inhibitors (TNFi), 0.5-3.9 for interleukin-17 inhibitors (IL-17i) and 0.8-3.3 for upadacitinib (UPA), as derived from available RCTs. Evidence from non-RCTs, reporting uveitis incidence rates per 100PY, ranged between 3.46-55.2 for etanercept, 1.38-15.7 for adalimumab, 1.82-25.9 for infliximab, 1.39-6.8 for golimumab, 0-9.4 for secukinumab and 0 for ixekizumab.

Monoclonal TNFi are still the preferred therapeutic choice in axSpA patients with prior or high risk of uveitis. IL-17i are identified as second line treatment option especially in uveitis refractory to TNFi. Finally, JAKi remain a promising alternative, with more evidence needed to further establish their so far proven efficacy.