title: Efficacy of anti-tumor necrosis factor therapy for extra-articular manifestations in patients with ankylosing spondylitis: a meta-analysis.
abstract: BACKGROUND
  We performed a meta-analysis to evaluate the effect of anti-tumor necrosis factor (TNF) therapy on the frequency of extra-articular manifestations (EAMs) in patients with ankylosing spondylitis (AS).
  
  
  METHODS
  We searched with the terms 'ankylosing spondylitis', 'infliximab', 'etanercept', 'adalimumab', 'golimumab', 'certolizumab', 'TNF inhibitor/blocker/antagonists' or 'anti-TNF' on MEDLINE, EMBASE and Cochrane Library for randomized controlled trials (RCTs) of ≥ 12 weeks with parallel or crossover design of TNF inhibitor versus placebo to treat uveitis, inflammatory bowel disease (IBD) and/or psoriasis of AS, published before February 2014.
  
  
  RESULTS
  We found 8 RCTs that fit our criteria. Anti-TNF therapy was associated with less uveitis than placebo in patients with AS (OR: 0.35, 95% CI: 0.15-0.81, P = 0.01). Subgroup analysis showed receptor fusion proteins were more efficacious for uveitis than placebo (OR: 0.30, 95% CI: 0.09-0.94, P = 0.04), but monoclonal antibodies were not (OR: 0.43, 95% CI: 0.12-1.49, P = 0.18). Anti-TNF therapy and placebo group did not significantly differ in treating IBD in AS patients (OR: 0.75, 95% CI: 0.25-2.29, P = 0.61). In subgroup analysis, neither monoclonal antibodies (OR: 0.45, 95% CI: 0.10-1.92, P = 0.28) nor receptor fusion proteins (OR: 1.52, 95% CI: 0.25-9.25, P = 0.65) significantly differed from placebo in treating IBD. We found no suitable reports on psoriasis.
  
  
  CONCLUSIONS
  Anti-TNF therapy was preventive for flares or new onset of uveitis in AS patients, and might be an alternative for these patients. However, monoclonal anti-TNF antibodies and TNF receptor fusion proteins were not efficacious for IBD in AS patients.
authors.affiliation: Second Departments of Rheumatology, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Tiexi District, Shenyang, 110022, , Liaoning, China. crystal0553@163.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Wu
authors.affiliation: First Departments of Rheumatology, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Tiexi District, Shenyang, 110022, Liaoning, China. guoyy_sjhospital@163.com.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Guo
authors.affiliation: Second Departments of Rheumatology, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Tiexi District, Shenyang, 110022, , Liaoning, China. xunn_sjhospital@163.com.
authors.forename: Nan-Nan
authors.initials: NN
authors.lastname: Xu
authors.affiliation: Second Departments of Rheumatology, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Tiexi District, Shenyang, 110022, , Liaoning, China. zhaos_sjhospital@163.com.
authors.forename: Shuai
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Second Departments of Rheumatology, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Tiexi District, Shenyang, 110022, , Liaoning, China. houlx_sjhospital@163.com.
authors.forename: Lin-Xin
authors.initials: LX
authors.lastname: Hou
authors.affiliation: Second Departments of Rheumatology, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Tiexi District, Shenyang, 110022, , Liaoning, China. jiaot_sjhospital@163.com.
authors.forename: Ting
authors.initials: T
authors.lastname: Jiao
authors.affiliation: Second Departments of Rheumatology, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Tiexi District, Shenyang, 110022, , Liaoning, China. zhangn_sjhospital@163.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
mesh_terms: D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000209:etiology; D011565:Psoriasis / Q000188:drug therapy* / Q000209:etiology; D013167:Spondylitis, Ankylosing / Q000150:complications*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014605:Uveitis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control
chemical_list: D014409:Tumor Necrosis Factor-alpha