Successful Use of Upadacitinib, a Selective JAK Inhibitor, in the Treatment of Two Cases of Recalcitrant Chronic Uveitis

TL;DR

Upadacitinib, a JAK1 inhibitor, successfully reduced inflammation in two patients with chronic uveitis who did not respond to other treatments.

Contribution

Demonstrates the potential of upadacitinib as a treatment for recalcitrant chronic uveitis.

Findings

A 59-year-old female with HLA-B27-positive Chron's disease showed improvement in uveitis symptoms with upadacitinib.

A 71-year-old female with birdshot chorioretinopathy improved after treatment with upadacitinib.

Upadacitinib may be effective for uveitis in autoimmune contexts or isolated cases.

Abstract

Immunomodulatory agents, including conventional immunosuppressive treatment and biologics, are the mainstay of treating chronic uveitis. Janus kinase (JAK) inhibitors, one of the newest biologics, have shown successful outcomes in treating autoimmune diseases such as rheumatoid arthritis and inflammatory bowel diseases by suppressing the JAK/signal transducers and transcription (STAT) pathway. We present two cases of recalcitrant chronic uveitis with significant improvement in intraocular inflammation by using upadacitinib, a selective JAK1 inhibitor.

The first case is a 59-year-old female with HLA-B27-positive Chron's disease and chronic anterior and intermediate uveitis who experienced an improvement in visual acuity, anterior chamber and vitreous inflammation, and cystoid macular edema on upadacitinib. The second patient is a 71-year-old female with birdshot chorioretinopathy, intolerant of initially used systemic immunosuppressive agents who showed significant improvement in vitreous inflammation, retinal phlebitis, and choroiditis after treatment with upadacitinib.

Utilizing JAK inhibitors such as upadacitinib in treating uveitis, whether in isolated forms or in the context of systemic autoimmune diseases, may require further evaluation by controlled cohort studies.

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