Journal Article

AB0388 JANUS KINASE INHIBITORS IN UVEITIS DUE TO IMMUNE-MEDIATED INFLAMMATORY DISEASES. MULTICENTER STUDY AND LITERATURE REVIEW

Beltrán, E., Esteban-Ortega, M. D. M., Munoz-Fernández, S., Sanchez-Bilbao, L., Maiz-Alonso, O., Jovani, V., Álvarez-Vega, J. L., Veroz González, R., Álvarez-Reguera, C., Calvo-Río, V., Martín-Varillas, J. L., Blanco, R., Demetrio-Pablo, R.

2024

Overview

Background:Uveitis may be severe ocular conditions refractory to conventional immunosuppressants and even biological therapy. Janus Kinase inhibitors (JAKINIB) had shown efficacy in refractory cases of different immune-mediated inflammatory diseases (IMID).Objectives:In patients with refractory uveitis treated with JAKINIB our aims were a) to evaluate effectiveness and safety of JAKINIB in patients of Spanish referral centers, b) Literature review.Methods:National multicenter study of 9 patients with refractory uveitis treated with JAKINIB. Efficacy was assessed with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, and presence of cystoid macular edema. The effectiveness of JAKINIB was compared between the baseline visit, 1st week, 1st and 6th month, and 1st year.For Literature review a search was conducted in PubMed, Embase and the Cochrane library from their inception to 1st January 2024. Original research articles studying JAKINIB treatment in patients with uveitis were included.Results:We have identified 9 cases in seven University Hospitals and 12 cases in the literature review. These 21 patients (14 women/ 7 men) (33 affected eyes), mean age 34±21.1 years, had different patterns of uveitis: panuveitis (n=10), anterior uveitis (n=10; 3 of them with Cystoid macular), and posterior (n=1).Most of uveitis were associated with IMID (n=18, 85.7%) while 3 cases (14.3%.), were idiopathic. The main underlying IMID were spondyloarthritis (n=7, 38.8%) and juvenile idiopathic arthritis (n=6, 33.3%) (Table 1).In addition to systemic corticosteroids, before JAKINIB, conventional (n= 18; 85.7%) and biological immunosuppressive drugs (n=18; 85.7%) were required. The JAKINIB most widely used was upadactinib (n= 9; 42.9%) followed by tofacitinib (n=7; 33.3%). In one patient with Blau Syndrome and uveitis, tofacitinib was switched to baricitinib due to severe lymphopenia. No serious adverse effects were found.After starting JAKINIB treatment, 21 patients presented clinical improvement, complete (n=20, 95.2%) or partial (n= 1; 4.8%). In this patient a reduction in the number of flares was observed (from 4 previous flares to 1 when on treatment).In patients of the multicenter study after 13 [5-20] months of follow-up, BCVA showed a rapid and maintained improvement (Figure 1). All patients had Tyndall + at baseline (n=9, 100%), with a decrease from the first month (n=3, 33.3%) and resolution by the sixth month. Two patients (22.2%) had cystic macular edema at baseline, which resolved at 3 months of follow-up in one case and at 12 months in the other patient.Conclusion:JAKINIB seems to be effective and safe in uveitis related to different IMID, even in patients refractory to previous biological drugs.REFERENCES:[1] Álvarez-Reguera C et al. Clinical and immunological study of Tofacitinib and Baricitinib in refractory Blau syndrome: case report and literature review. Ther Adv Musculoskelet Dis. 2022Figure 1. Rapid and maintained improvement of best corrected visual acuity (BCVA) following the initiation of JAKINIB.Table 1.Cases reports and Literature review of patients with uveitis treated with Janus Kinase Inhibitors.Acknowledgements:NIL.Disclosure of Interests:None declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Acuity / Anterior chamber / Arthritis / Biological products / Corticosteroids / Edema / Enzyme inhibitors / Eye diseases / Immunosuppressive agents / Inflammatory diseases / Janus kinase / Literature reviews / Lymphopenia / Patients / Rheumatic diseases / Scientific Abstracts / Targeted synthetic drugs / Uveitis