Case Report: A Promising Treatment Strategy for Noninfectious Uveitis

Abstract

Background: Uveitis refers to inflammation in the uvea, retina, retinal blood vessels, and vitreous, which can lead to irreversible eye damage and permanent vision loss. Glucocorticoid drugs are the first-line treatment, but side effects, such as obesity and hyperglycemia, can occur. Therefore, biologics have become a new treatment choice.Case Presentation: A 18-year-old girl developed eye pain and was diagnosed with binocular uveitis. Prednisone 50 mg was administered once a day, and the redness and pain in both eyes improved. Later, the prednisone dose was gradually reduced, and treatment was discontinued 3 years ago. Two years ago, the patient’s condition relapsed, with both eyes becoming red and painful. She was administered prednisone 20 mg once daily and adalimumab. Visual acuity in both eyes continued to progressively decrease, accompanied by cataracts. At the same time, the patient experienced complications, including obesity and hyperglycemia. Subsequently, a new treatment regimen, oral prednisone 20 mg once a day, tofacitinib 5 mg twice a day, and methotrexate 10 mg once a week, as well as the use of insulin to control blood sugar, was initiated. One month later, the patient’s redness and eye pain eased, and her vision gradually improved. The dosage of prednisone was gradually reduced to 5 mg once daily. At the same time, her blood sugar returned to normal, and insulin was stopped.Outcomes: The patient was treated with tofacitinib for 10 months. Subsequently, her best-corrected visual acuity of the right eye rose from 0.06 to 0.075, and the best-corrected visual acuity of the left eye rose from CF/30 cm to CF/100 cm. Redness and eye pain were relieved, her glucocorticoid consumption reduced from 15 to 2.5 mg, and her blood sugar gradually normalized.Conclusion: This case study shows that tofacitinib relieves ocular inflammation in patients with uveitis and improves eyesight. We believe that JAK inhibitors could be another treatment option for noninfectious uveitis in patients who do not respond to conventional anti-TNF-α inhibitors (such as adalimumab).

Treatment Options in Pediatric Behçet’s Disease

“…In a mouse model of experimental autoimmune uveitis, tofacitinib that exerts a pan-JAK inhibition, significantly suppressed IFN-γ secretion and the development of uveitis, without influencing the adaptive IL-17 response [ 196 ]. The successful use of JAK inhibitors in the treatment of severe refractory non-infectious uveitis has been recently reported in some clinical cases [ 197 – 200 ]. A growing interest around JAK inhibitors is also expressed by the ongoing trials: two are phase II trials, one involving filgotinib (NCT03207815) and another involving tofacitinib (NCT03580343), and one is a phase III trial on pediatric patients affected by juvenile idiopathic arthritis-associated uveitis (NCT04088409).…”