Background: Uveitis is a complex disease eye disease. Anterior uveitis can be a caused by multiple systemic rheumatic diseases as well as infections. Treatment of anterior uveitis can be challenging in cases where it becomes refractory to steroid sparing agents. Tnf blockers have shown good efficacy in anterior uveitis. Some case reports suggest good response to tofacitinib in anterior uveitis.

Objectives: To evaluate the effect of tofacitinib in refractory uveitis patients.

Methods: It was a prospective observational study of 29 patients of refractory anterior uveitis. The primary disease with anterior uveitis was ankylosing spondylitis, psoriasis, psoriatic arthritis, bechet’s disease, sarcoidosis, systemic lupus erythematosus (SLE), IBD (inflammatory bowel disease) associated arthritis or idiopathic uveitis. Those patients of uveitis who failed topical therapy, were given steroids (1 mg/kg prednisolone) along with steroid sparing immunosuppressant including methotrexate, mycophenolate mofetil, cyclosporine, cyclophosphamide or azathioprine. Tofactinib was given to patients who failed topical and oral therapy in form of combination of prednisone (failure to maintain 7.5 mg or below after 3 months of initiation) and at least 1 other systemic immunosuppressive drug (given in combination with steroids for atleast 3 months). These 29 refractory uveitis patients were included in the study and were given tofacitinib in dose of 5 mg twice a day. Patients were maintained on tofacitinib 5 mg twice a day and steroids were tapered and stopped in response to improvement in visual acuity and decrease in inflammation in anterior chamber as recorded by ophthalmologist. Patients were followed up for 12 months after starting tofacitinib. Tnf blockers were not used in any case.

Results: There were 13 men and 16 women (mean age, 34.6 years) with anterior uveitis. The most common associations of uveitis were ankylosing spondylitis in 9 patients, bechet’s in 3 patients, sarcoidosis in 5 patients, psoriatic arthritis in 3 patients, SLE, psoriasis and IBD arthritis in 1 patient each, idiopathic uveitis where disease could not be ascertained was seen in 6 patients as shown in Table 1. Tofactinib was used amongst patients who failed to taper steroids as steroid sparing agents - methotrexate in 18 patients, mycophenolate mofetil in 9 and azathioprine in 2 patients. Out of 29 patients treated with tofacitinib, 26 (89.65%) patients were able to achieve remission in uveitis with tapering off steroids within 3 months. However, 3(10.35%) patients on tofactinib could not achieve remission and/or taper steroids. The non responsive patients had SLE, IBD associated arthritis and bechet’s disease. Out of 26 patients who responded to tofacitinib, steroids were tapered to zero doses over 4 weeks in 19 patients (73.1%) and remaining 7 (26.9%) over 6 weeks.

Conclusion: This study shows tofactinib 5 mg twice a day dose can be used as an alternative agent to tnf blockers in refractory uveitis in reducing inflammation and reducing steroid dosage.

No conflict of interest

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.