AB1470 Janus Kinase Inhibitors in Severe Inflammatory Ocular Pathology. Multicenter Study and Literature Review

1. Sanchez-Bilbao, L. ²
2. Martín-Varillas, J. L. ³
3. Calvo-Río, V. ²
4. Álvarez Vega, J. L. ⁵
5. Beltrán, E. ⁴
6. Esteban-Ortega, M. D. M. ¹
7. Muñoz Fernandez, S. ¹
8. Maiz, O. ⁶
9. Torre-Salaberri, I. ⁷
10. Urruticoechea-Arana, A. ⁸
11. Valls-Pascual, E. ⁹
12. Álvarez-Reguera, C. ²
13. Demetrio-Pablo, R. ²
14. Blanco, R. ²

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DOI: 10.1136/ANNRHEUMDIS-2023-EULAR.5948 GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Annals of the Rheumatic Diseases

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Abstract

Background Inflammatory ocular pathology (IOP) includes internal (uveitis) and external (mainly ocular surface pathology) involvement. IOP may be severe ocular conditions refractory to conventional and biological immunosuppressants. Janus Kinase inhibitors (JAKINIB) had shown efficacy in refractory cases of different immune-mediated diseases (IMID).Objectives In patients with refractory IOP treated with JAKINIB our aims were a) to assess the patients of Spanish referral centers, b) Literature review.Methods Multicenter study of 11 patients with refractory IOP treated with JAKINIB. For Literature review a search was conducted in PubMed, Embase and the Cochrane library from their inception to 1st January 2023. In addition, a therapeutical approach of refractory IOP is proposed.Results We have identified 11 cases in eight University Hospitals and 13 cases in the literature review. These 24 patients (17 women/ 7 men) (35 affected eyes), mean age 38.9±21.9 years, had different refractory IOP (uveitis=14; scleritis=5, PUK=5).Most of IOP were associated with IMID (n=19, 79.2%). The main underlying IMID were rheumatoid arthritis (n=6, 25%) and juvenile idiopathic arthritis (n=5, 20.8%) (TABLE 1).In addition to systemic corticosteroids, before JAKINIB, conventional (n= 23; 95.8%) and biological immunosuppressive drugs (n=18; 75%) were required. The JAKINIB most widely used was tofacitinib (n= 11; 45.8%). In one patient with Blau Syndrome and uveitis, tofacitinib was switched to baricitinib due to severe lymphopenia. In two other patients, UPA was discontinued due to anemia and skin adverse reaction. Finally, only in one patient baricitinib was withdrawn due to lack of improvement.After starting JAKINIB, 23 patients presented clinical improvement, complete (n=21, 87.5%) or partial (n= 2; 8.3%).Based on these data a therapeutical approach of refractory IOP was proposed (FIGURE 1).Conclusion JAKINIB may be an effective and safe therapy in IOP refractory to conventional or even biological immunosuppressive therapy.