Abstract
Purpose :
There have been a few case reports demonstrating the efficacy of Janus kinase inhibitors (Jakinibs) in the treatment of uveitis. This is the largest case series on the efficacy and safety profile of two Jakinibs, tofacitinib and upadacitinib, for patients with noninfectious uveitis.
Methods :
This was an IRB-approved single-institution retrospective case series of patients who were taking tofacitinib or upadacitinib for a diagnosis of noninfectious uveitis. The primary outcome was defined as the number of flares in the year prior to and year after initiating the Jakinib.
Results :
8 patients with noninfectious uveitis were included. Uveitis diagnoses include scleritis (n=4), iritis (n=1), intermediate uveitis (n=1), retinal vasculitis (n=1) and panuveitis (n=1). Mean age was 44.4 years (range 27 – 65). 4 patients had bilateral disease. 2 patients had isolated ocular disease and 6 had an associated systemic autoimmune disease. All patients had been treated with other immunomodulatory therapy (IMT) prior to initiating a Jakinib as summarized in Table 1. Mean duration of Jakinib therapy was 26 months. 5 patients received tofacitinib only, 2 patients received upadacitinib only, and 1 patient received both. 5 patients received concomitant IMT with their Jakinib.
5 patients’ uveitis was active in the year prior to initiating a Jakinib, ranging from 1 – 3 flares. Of those 5 patients, 1 failed to achieve control with tofacitinib; however, upon initiation of upadacitinib, she only experienced one mild flare that resolved with an oral prednisone taper. 1 patient failed to achieve control with tofacitinib initially but did well after a course of oral prednisone. The 3 patients who were flare-free of uveitis in the year prior were initiated on a Jakinib for poor systemic disease control. 2 of the 3 patients remained flare-free in the following year. Overall, the Jakinibs were well tolerated with the most common side effect of tofacitinib being gastrointestinal upset (n=2). There were no reported major adverse cardiovascular events (MACEs).
Conclusions :
Jakinibs should be considered for the treatment of uveitis in those that are treatment refractory to other IMT that is traditionally used to control uveitis. Trialing of Jakinibs must be exercised with extreme caution due to the increased risk of MACE although we had no events in the 8 patients in this cohort.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.