Background/Purpose: Non-infectious uveitis may be related to several immune-mediated diseases (IMIDs). Those that are refractory to conventional therapy or biologics may lead to severe ocular damage. Janus Kinase inhibitors (JAKINIB) had shown efficacy in refractory cases. The objectives were to assess the efficacy and safety of JAKNIBs in patients with refractory uveitis due to IMIDs, and to review the updated literature.

Methods: Multicenter study of 18 patients with refractory uveitis due to IMIDs treated with different JAKNIBs. Our ocular variables evaluated were best corrected visual acuity (BCVA), anterior chamber cells and presence of cystoid macular edema, and they were recorded from baseline up to 1 year treatment.We included patients with non-infectious uveitis treated with JAKNIBs for the literature review searched on PubMed, Embase and the Cochrane library up to 1st December 2024.

Results: We studied 18 patients from Spain and 13 cases from the literature were reviewed. They were 24 women and 7 men. There were panuveitis (n=12), anterior (n=17;), intermediate (n=1) and posterior uveitis (n=1).26 patients with uveitis were secondary to IMIDs while 5 cases were idiopathic. The main underlying IMIDs were spondylarthritis (n=14) and juvenile idiopathic arthritis (n=6) (Table).They received treatment with conventional (n=26) or biological immunosuppressive drugs (n=27) before the JAKNIBs therapy. The JAKINIB most widely used was Upadacitinib (n= 17). Complete clinical improvement was recorded after starting JAKNIBs treatment. 28 patients presented a complete improvement while the remaining patients showed partial improvement. In the multicenter study, BCVA showed a rapid and maintained improvement (Figure 1) after 13 months of follow-up. From 14 patients with Tyndall + at baseline, 4 of them had a partial decrease in the first month (n=4) and resolved by the sixth month (Figure 2). Two patients had cystic macular edema at baseline, resolved at 3 months of follow-up. No serious adverse effects were found.

Conclusion: Treatment with JAKNIBs in uveitis due to different IMIDs may be effective and safe, even in refractory to previous biological drugs patients.

TABLE. Case reports and literature review of patients with uveitis treated with Janus Kinase Inhibitors

FIGURE 1. Rapid improvement of best corrected visual acuity (BCVA) following the start of JAKINIB

FIGURE 2. Decrease of Tyndall following the initiation of JAKNIB

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/multicenter-study-and-literature-review-of-jak-inhibitor-treatment-in-refractory-uveitis-due-to-different-immune-mediated-inflammatory-pathologies/