The use of Janus kinase inhibitors to treat noninfectious uveitis

To present a case series of eight patients with noninfectious chronic uveitis treated at a single institution with one of two JAK inhibitors (Jakinibs), upadacitinib or tofacitinib.

A retrospective chart review of patients seen by the uveitis service from 2015 to 2022 treated with upadacitinib and/or tofacitinib was performed. All patients included had previously failed alternative immunomodulatory therapy (IMT), had consistent ophthalmic evaluations for at least 6 months, and stayed on the Jakinib for at least 3 months. Eight patients were included. Demographic information was collected. Flares were classified clinically through visual acuity, symptoms, examination, and imaging. Side effects of the Jakinibs were recorded.

The median length of Jakinib therapy duration was 29.5 months (range 6 months-43 months). Five patients were initiated on a Jakinib due to poor control of their ocular inflammatory diseases. Four of these patients achieved control with tofacitinib with or without additional steroid use; one patient achieved control with upadacitinib with one mild flare that resolved with systemic steroid use. Three patients started a Jakinib due to poor systemic disease control. Two of those remained flare-free of uveitis in the following year. The third patient had a flare that resolved with topical and oral therapy. Gastrointestinal upset was the most common side effect of tofacitinib. Upadacitinib had no reported side effects.

Jakinibs may have a role in treatment of refractory noninfectious uveitis after failing conventional IMT. Both Jakinibs were well tolerated with a low incidence of side effects.