Beneficial Effect of Upadacitinib in an Adult Patient with Juvenile Idiopathic Arthritis-associated Uveitis after Unsatisfactory Response to Tofacitinib: A Case Report

Baquet-Walscheid, Karoline; Heinz, Carsten; Rath, Thomas; Scheel, Martin; Heiligenhaus, Arnd

doi:10.1080/09273948.2022.2069128

Cited by 12 publications

(3 citation statements)

References 10 publications

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“…Phase II studies in idiopathic AU have shown a reduction in the risk of uveitis flare, 61 whilet case report and case series in juvenile idiopathic arthritis (JIA) patients with recalcitrant AU have reported success. 62,63 A phase III clinical trial evaluating baricitinib in JIA AU is ongoing. 64 Mechanistically, it is not surprising that JAKi are efficacious against AU.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Uveitis in Patients With Axial Spondylarthritis Treated With Biologics or Targeted Synthetics: A Systematic Review and Network Meta‐Analysis

Bechman,

Yang,

Adas

et al. 2024

Arthritis & Rheumatology

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ObjectiveUveitis is a common extra‐articular manifestation of axial spondylarthritis (AxSpA). We set to evaluate risk of anterior uveitis (AU) with biologics and synthetic disease‐modifying drugs in AxSpA.MethodsWe conducted a systematic review and meta‐analysis to identify phase II/III double blinded randomised controlled trials of anti‐TNF monoclonal antibodies (mAb) anti‐IL17 and JAK inhibitors (JAKi) in AxSpA. Patient‐exposure years (PEY) were calculated using per‐protocol approach. Incidence rate (IR) of AU /100 person‐years were calculated by treatment group using random effects approach. Network meta‐analysis (NMA) was used to estimate risk of AU in treatment groups, expressed as incidence rate ratios (IRR). Bias was assessed using Cochrane Risk of Bias‐2 tool.ResultsForty‐four trials were included: 17 anti‐TNF mAb (1004 PEY), 9 etanercept (180 PEY), 13 anti‐IL17 (1834 PEY) and 6 JAKi (331 PEY). IR of AU were anti‐TNF mAb: 4.1 [95%CI 0, 8.5], etanercept: 5.4[0, 16.0], anti‐IL17: 2.8 [1.6, 4.1] JAKi: 1.5 [0.0, 3.0] and placebo: 10.8 [7.4, 14.1]. In NMA, IRR of treatments compared with placebo were anti‐TNF mAb: 0.32[0.10,1.04], etanercept 0.42 [0.08, 2.38], anti‐IL17: 0.43[0.19, 0.98] and JAKi: 0.32[0.06, 1.67]. Comparisons between anti‐TNF mAb, anti‐IL17 and JAKi did not demonstrate any significant difference in AU risk. Using the SUCRA approach to rank AU risk, anti‐TNF mAbs were associated with the lowest risk followed by JAKi, anti‐IL17 and etanercept. All treatments were ranked superior to placebo.ConclusionAnti‐TNF mAbs, JAKi and anti‐IL17 appear protective against AU events in individuals with AxSpA, with no significant differences in risk of AU between treatments.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Incidence of Uveitis in Patients With Axial Spondylarthritis Treated With Biologics or Targeted Synthetics: A Systematic Review and Network Meta‐Analysis

Bechman,

Yang,

Adas

et al. 2024

Arthritis & Rheumatology

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“…Verschiedene Kasuistiken zur Wirksamkeit von Tofacitinib bei JIA-assoziierter Uveitis wurden publiziert, in denen ein vorteilhafter Effekt der Arzneimittel auf die Arthritis und Uveitisaktivität und das damit verbundene Makulaödem beschrieben wurde [29,30]. Andere Kasuistiken belegen einen positiven Effekt von Upadacitinib (einem selektiven JAK1-Inhibitor) bei un-zureichender Wirkung von cs/bDMARD und Tofacitinib auf den Krankheitsverlauf der JIA-assoziierten Uveitis [31]. Dies legt nahe, dass bei unzureichender Wirksamkeit von Tofacitinib ein Wechsel zu einem anderen JAK-Inhibitor eine erfolgreiche Strategie in der Behandlung der JIA-assoziierten Uveitis sein kann.…”

Section: Therapieschrittunclassified

Uveitis bei juveniler idiopathischer Arthritis

Heiligenhaus,

Baquet-Walscheid,

Tappeiner

2023

Arthritis und Rheuma

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ZUSAMMENFASSUNGDarstellung der aktualisierten deutschsprachigen interdisziplinären Leitlinie zur Diagnostik und Therapie der juvenilen idiopathischen Arthritis (JIA)-assoziierten Uveitis. Nach JIA-Erstdiagnose sollten zeitnah regelmäßige augenärztliche Kontrollen erfolgen mit dem Ziel, die Uveitis vor Manifestation irreversibler Folgeschäden zu diagnostizieren. Zur antientzündlichen Therapie finden aktuell Kortikosteroide, konventionell synthetische (cs), biologische (b) und andere Disease-Modifying Antirheumatic Drugs (DMARD) Verwendung. Eine enge Kooperation durch einen mit der JIA-assoziierten Uveitis und ihrer Behandlung erfahrenen Augenarzt und einen Kinder- und Jugendrheumatologen sollte gewährleistet werden. Frühzeitige Diagnose und aktuelle leitliniengerechte Therapie können die Langzeitprognose der JIA-assoziierten Uveitis wesentlich verbessern. Ausgewählte Kasuistiken illustrieren das therapeutische Management bei therapierefraktärem Krankheitsverlauf.

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“…Nevertheless, some refractory cases are reported upon adalimumab or infliximab treatment, with or without evidence of biologic-specific autoantibodies, and may need alternative treatments. Five cases of JIA-related uveitis efficiently treated with JAKis (baricitinib, n = 3; tofacitinib, n = 1; upadacitinib, n = 1) have been reported to date after failure of several biological treatments including TNFα antagonists [47,48]. One patient treated with upadacitinib achieved clinical joint and ophthalmological remission after tofacitinib failure.…”

Section: Jak Inhibition In Uveitis Alopecia Areata Lung Disease and M...mentioning

confidence: 99%

JAK Inhibition in Juvenile Idiopathic Arthritis (JIA): Better Understanding of a Promising Therapy for Refractory Cases

Melki

Frémond

2023

JCM

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Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases with probably differential underlying physiopathology. Despite the revolutionary era of biologics, some patients remain difficult to treat because of disease severity, drug adverse events, drug allergy or association with severe comorbidities, i.e., uveitis, interstitial lung disease and macrophagic activation syndrome. Janus Kinase (JAK) inhibitors are small molecules that target JAK/Signal Transducers and Activators of Transcription (STAT) pathways, which could then prevent the activity of several proinflammatory cytokines. They may provide a useful alternative in these cases of JIA or in patients actually affected by Mendelian disorders mimicking JIA, such as type I interferonopathies with joint involvement, and might be the bridge for haematopoietic stem cell transplantation in these disabling conditions. As these treatments may have side effects that should not be ignored, ongoing and further controlled studies are still needed to provide data underlying long-term safety considerations in children and delineate subsets of JIA patients that will benefit from these promising treatments.

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Beneficial Effect of Upadacitinib in an Adult Patient with Juvenile Idiopathic Arthritis-associated Uveitis after Unsatisfactory Response to Tofacitinib: A Case Report

Cited by 12 publications

References 10 publications

Incidence of Uveitis in Patients With Axial Spondylarthritis Treated With Biologics or Targeted Synthetics: A Systematic Review and Network Meta‐Analysis

Incidence of Uveitis in Patients With Axial Spondylarthritis Treated With Biologics or Targeted Synthetics: A Systematic Review and Network Meta‐Analysis

Uveitis bei juveniler idiopathischer Arthritis

JAK Inhibition in Juvenile Idiopathic Arthritis (JIA): Better Understanding of a Promising Therapy for Refractory Cases

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