1128: Refractory Inflammatory Ocular Pathology and Treatment with Janus Kinase Inhibitors. Multicenter Study and Literature Review

Carmen Lasa-Teja¹, Lara Sanchez-Bilbao², Jose Luis Martin-Varillas³, Vanesa Calvo Río⁴, José Luis Álvarez-Vega⁵, Emma Beltran-Catalan⁶, María del Mar Esteban-Ortega⁷, Santiago Muñoz⁷, Olga Maiz⁸, Ignacio Torre-Salaberri⁹, Ana Urruticoechea¹⁰, Elia Valls-Pascual¹¹, Raúl Veroz¹², Carmen Alvarez Reguera¹³, Rosalía Demetrio¹³ and Ricardo Blanco¹⁴, ¹Hospital Universitario Marqués de Valdecilla. IDIVAL, Immunopathology Group, Santander, Spain, ²Hospital Universitario Marques de Valdecilla, Santander, Spain, ³Hospital de Laredo, Laredo, Spain, ⁴Valdecilla Hospital, Santander, Spain, ⁵Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain, ⁶HOSPITAL DEL MAR, Barcelona, Spain, ⁷Hospital Infanta Sofia, Madrid, Spain, ⁸Hospital Universitario de Donostia. San Sebastián, Spain., Donosti, Spain, ⁹Hospital Universitario de Basurto, Bilbao, Spain, ¹⁰Hospital Can Misses, Ibiza, Spain, ¹¹Hospital Universitario Doctor Peset. Alicante, Spain., Valencia, Spain, ¹²Hospital de Mérida, Mérida. Spain., Mérida, Spain, ¹³Hospital Universitario Marqués de Valdecilla, Santander, Spain, ¹⁴Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Background/Purpose: Inflammatory ocular pathology (IOP) includes internal (uveitis) and external [mainly ocular surface pathology such as epi/scleritis and peripheral ulcerative keratitis (PUK)] involvement. IOP 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).
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 1^st January 2023. Original research articles studying JAKINIB treatment in patients with IOP were included. 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%) while 5 cases (20.8%.), were idiopathic. The main underlying IMID were rheumatoid arthritis (n=6, 25%), juvenile idiopathic arthritis (n=5, 20.8%) and spondyloarthritis (n=4; 16.7%) (TABLE). Uveitis (n=14) followed by ocular surface pathology (n=10) were the most frequent subtypes of IOP. Patterns of uveitis were panuveitis (n=8), anterior uveitis (n=5; 2 of them with Cystoid macular), and posterior (n=1). Ocular surface pathology was due to scleritis (n=5) and PUK (n=5). In addition to systemic corticosteroids, before JAKINIB, conventional (n= 23; 95.8%) and biologicalimmunosuppressive drugs (n=18; 75%) were required. The JAKINIB most widely used was tofacitinib (n= 11; 45.8%) followed by baricitinib (n=8; 33.3%). 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 treatment, 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).

Conclusion: JAKINIB may be an effective and safe therapy in IOP refractory to conventional or even biological immunosuppressive therapy.






C. Lasa-Teja: None; L. Sanchez-Bilbao: None; J. Martin-Varillas: None; V. Calvo Río: None; J. Álvarez-Vega: None; E. Beltran-Catalan: None; M. Esteban-Ortega: None; S. Muñoz: None; O. Maiz: None; I. Torre-Salaberri: None; A. Urruticoechea: None; E. Valls-Pascual: None; R. Veroz: None; C. Alvarez Reguera: None; R. Demetrio: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6.