Vitale Antonio, Palacios-Olid Judith, Caggiano Valeria, Ragab Gaafar, Hernández-Rodríguez José, Pelegrín Laura, Mejía-Salgado Germán, Zarate-Pinzón Laura, Gentileschi Stefano, Sota Jurgen, Fonollosa Alex, Carreño Ester, Gaggiano Carla, Amin Rana Hussein, Balistreri Alberto, Narváez Javier, Tosi Gian Marco, Frediani Bruno, Cantarini Luca, de-la-Torre Alejandra, Fabiani Claudia
Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Azienda Ospedaliero-Universitaria Senese [European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy.
Front Med (Lausanne). 2024 Aug 23;11:1439338. doi: 10.3389/fmed.2024.1439338. eCollection 2024.
Non-infectious inflammatory ocular diseases pose significant challenges in diagnosis and management, often requiring systemic immunosuppressive therapy. Since Janus kinase (JAK) inhibitors may represent a novel therapeutic option for these disorders, the present study aimed to expand current knowledge about their efficacy and safety in patients with these conditions.
This prospective cohort study included 12 adult patients from the international AutoInflammatory Disease Alliance (AIDA) Network registries dedicated to non-infectious ocular inflammatory conditions. We assessed ocular flares, visual acuity, disease course, and complications before and after initiating JAK inhibitor therapy.
Ocular inflammation was related to a systemic disease in 8 (66.7%) patients as follows: spondyloarthritis ( = 3), peripheral psoriatic arthritis ( = 1), rheumatoid arthritis ( = 1), antinuclear antibodies (ANA) positive juvenile idiopathic arthritis ( = 1), Behçet's syndrome ( = 1), Vogt-Koyanagi-Harada syndrome ( = 1). In total, 4 patients received baricitinib, 1 patient received tofacitinib, and 7 patients underwent upadacitinib treatment. The overall average duration of JAK inhibitors treatment was 8.6 ± 5.5 months (ranging from 3 to 20 months). At the last assessment, ocular disease control was complete in 12/12 patients. One patient discontinued baricitinib due to poor compliance after a 12-month relapse-free period. The incidence of ocular flares was 125 episodes/1.000 person-months prior to the initiation of JAK inhibitors and 28.6 episodes/1.000 person-months thereafter. The incidence rate ratio for experiencing a relapse before starting a JAK inhibitor compared to the following period was 4.37 (95% CI 1.3-14.7, -value: 0.02).
JAK inhibitors demonstrate efficacy and safety in controlling ocular inflammatory relapses, confirming that they represent a valuable treatment option for patients with non-infectious inflammatory ocular diseases resistant to conventional treatments.
非感染性炎性眼病在诊断和治疗方面带来了重大挑战，通常需要全身免疫抑制治疗。由于Janus激酶（JAK）抑制剂可能是治疗这些疾病的一种新的治疗选择，本研究旨在扩展目前关于其在这些疾病患者中的疗效和安全性的知识。
这项前瞻性队列研究纳入了12名来自国际自身炎症性疾病联盟（AIDA）网络登记处的成年患者，这些登记处专门针对非感染性眼部炎症性疾病。我们在开始JAK抑制剂治疗前后评估了眼部炎症发作、视力、病程和并发症。
8名（66.7%）患者的眼部炎症与全身性疾病相关，具体如下：脊柱关节炎（n = 3）、外周型银屑病关节炎（n = 1）、类风湿关节炎（n = 1）、抗核抗体（ANA）阳性幼年特发性关节炎（n = 1）、白塞病（n = 1）、伏格特-小柳-原田综合征（n = 1）。共有4名患者接受了巴瑞替尼治疗，1名患者接受了托法替布治疗，7名患者接受了乌帕替尼治疗。JAK抑制剂治疗的总体平均持续时间为8.6±5.5个月（范围为3至20个月）。在最后一次评估时，12/12名患者的眼部疾病得到了完全控制。1名患者在无复发12个月后因依从性差而停用巴瑞替尼。在开始JAK抑制剂治疗前，眼部炎症发作的发生率为125次/1000人月，之后为28.6次/1000人月。与之后相比，开始JAK抑制剂治疗前复发的发病率比值为4.37（95%CI 1.3 - 14.7，P值：0.02）。
JAK抑制剂在控制眼部炎症复发方面显示出疗效和安全性，证实它们是对传统治疗耐药的非感染性炎性眼病患者的一种有价值的治疗选择。
