Background: Inflammatory ocular pathology (IOP) includes internal (uveitis) and external [mainly ocular surface pathology (OSP) such as epi/scleritis and peripheral ulcerative keratitis (PUK)] involvement. OSP may be a 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).

Objectives: In patients with refractory OSP treated with JAKINIB our aims were a ) to assess the patients of Spanish referral centers, b ) Literature review.

Methods: Multicenter study of 7 patients with refractory OSP treated with JAKINIB. For Literature review a search was conducted in PubMed, Embase and the Cochrane library from their inception to 1 ^st January 2024. Original research articles studying JAKINIB treatment in patients with IOP were included. In addition, a therapeutical approach of refractory OSP is proposed.

Results: We have identified 7 cases in seven University Hospitals and 20 cases in the literature review. These 27 patients (20 women/ 7 men) (35 affected eyes), mean age 46.8±13.4 years, had different refractory OSP (PUK=5; scleritis=22). Patterns of scleritis were diffuse or nodular (n=24), necrotizing (n=2) and posterior (n=1).

Most of OSP were idiopathic (n=14, 51.9%) while 13 cases (48.1%.), were associated with IMID. The main underlying IMID were rheumatoid arthritis (n=7, 50%) and spondyloarthritis (n=2; 14.3%) (Table 1).

In addition to systemic corticosteroids, before JAKINIB, conventional (n= 22; 81.5%) and biological immunosuppressive drugs (n=12; 44.4%) were required. The JAKINIB most widely used was tofacitinib (n= 19; 70.4%) followed by baricitinib (n=4; 14.8%) and upadacitinib (n=4, 14.8%).

In two patients, UPA was discontinued due to anemia and skin adverse reaction. No serious adverse effects were found. Finally, only in one patient baricitinib was withdrawn due to lack of improvement.

After starting JAKINIB treatment, 26 patients presented clinical improvement, complete (n=24, 88.8%) or partial (n= 2; 7.4%).

Based on these data a therapeutical approach of refractory OSP was proposed (Figure 1).

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

REFERENCES: [1] Calvo-Río V et al. Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review. Ther Adv Musculoskelet Dis. 2022 Nov 19.

Table 1. Cases reports and Literature review of patients with refractory inflammatory ocular surface pathology treated with Janus Kinase Inhibitors.

Figure 1.

Therapeutical approach of refractory inflammatory ocular surface pathology

Acknowledgements: NIL.

Disclosure of Interests: None declared.