Therapeutic Potential of Upadacitinib in Adolescents with Idiopathic Chronic Panuveitis Who Lost Response to Adalimumab

Area of Science:

• Ophthalmology
• Immunology
• Rheumatology

Background:

• Idiopathic chronic refractory panuveitis poses a significant treatment challenge in adolescents.
• Previous treatments including systemic glucocorticoids, immunosuppressants, and anti-TNF biologics often yield inadequate responses.

Purpose of the Study:

• To evaluate the efficacy and safety of upadacitinib in adolescents with refractory idiopathic chronic panuveitis.
• To assess the potential of upadacitinib as an alternative treatment for this challenging condition.

Main Methods:

• Retrospective case series of four adolescent patients diagnosed with idiopathic chronic refractory panuveitis.
• Administration of upadacitinib following failure of conventional therapies.
• Monitoring of ocular inflammation, treatment response, and adverse events over a 9-10 month follow-up period.

Main Results:

• Upadacitinib demonstrated rapid reduction in ocular inflammation within the first month across all four cases.
• Two patients achieved complete resolution of anterior and vitreous inflammation with significant posterior segment improvement.
• Two patients experienced upper respiratory tract infections leading to recurrence of ocular inflammation, requiring glucocorticoid management.

Conclusions:

• Upadacitinib appears to be an effective treatment option for adolescents with refractory idiopathic chronic panuveitis.
• The risk of infection associated with upadacitinib necessitates careful monitoring in this patient population.