The use of Janus kinase inhibitors to treat noninfectious uveitis

Sep 29, 2026

Retrospective chart review of eight patients with noninfectious chronic uveitis treated at a single institution with one of two JAK inhibitors, upadacitinib or tofacitinib, from 2015 to 2022. Patients had previously failed alternative immunomodulatory therapy and remained on the Jakinib for at least three months with consistent ophthalmic follow-up for 6+ months. Flares were classified using visual acuity, symptoms, exam, and imaging. Gastrointestinal upset was most common with tofacitinib, while upadacitinib had no reported side effects.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Objective

Subjects/Methods

Results

Conclusion

Introduction

Materials and Methods

[www.nature.com/eye](www.nature.com/eye) ARTICLE OPEN The use of Janus kinase inhibitors to treat noninfectious uveitis Madeline Beckman 1, Sunil K. Srivastava1,2, Careen Y. Lowder1, Kim Baynes1, Ashley Lowe1 and Sumit Sharma 1,2,3 ✉ © The Author(s) 2025 OBJECTIVE: To present a case series of eight patients with noninfectious chronic uveitis treated at a single institution with one of two JAK inhibitors (Jakinibs), upadacitinib or tofacitinib. SUBJECTS/METHODS: A retrospective chart review of patients seen by the uveitis service from 2015 to 2022 treated with upadacitinib and/or tofacitinib was performed. All patients included had previously failed alternative immunomodulatory therapy (IMT), had consistent ophthalmic evaluations for at least 6 months, and stayed on the Jakinib for at least 3 months. Eight patients were included. Demographic information was collected. Flares were classified clinically through visual acuity, symptoms, examination, and imaging. Side effects of the Jakinibs were recorded. RESULTS: The median length of Jakinib therapy duration was 29.5 months (range 6 months–43 months) . Five patients were initiated on a Jakinib due to poor control of their ocular inflammatory diseases. Four of these patients achieved control with tofacitinib with or without additional steroid use; one patient achieved control with upadacitinib with one mild flare that resolved with systemic steroid use. Three patients started a Jakinib due to poor systemic disease control. Two of those remained flare-free of uveitis in the following year. The third patient had a flare that resolved with topical and oral therapy. Gastrointestinal upset was the most common side effect of tofacitinib. Upadacitinib had no reported side effects. CONCLUSION: Jakinibs may have a role in treatment of refractory noninfectious uveitis after failing conventional IMT. Both Jakinibs were well tolerated with a low incidence of side effects. Eye (2026) 40:91–97; [https://doi.org/10.1038/s41433-025-04065-w](https://doi.org/10.1038/s41433-025-04065-w) INTRODUCTION Chronic noninfectious uveitis can be treated with either local corticosteroid therapy or systemic immunosuppression. Adalimumab (Humira; AbbVie Inc., North Chicago, IL), a fully humanised tumour necrosis factor-α (TNF-α) antibody, was the first noncorticosteroid approved medication for the treatment of noninfectious intermediate, posterior, and panuveitis [1, 2]. Other steroidsparing maintenance therapy options are all off label, including but not limited to the use of antimetabolites such as methotrexate and mycophenolate mofetil, calcineurin inhibitors such as cyclosporine and tacrolimus, and other biologic therapies [3]. Despite its success, 53.6% of patients had treatment failure with adalimumab at month 12 in the VISUAL-1 study [1]. A randomised control trial comparing the treatment of methotrexate tomycophenolate mofetil showed a 6 month failure rate of 25.6% and 44.7%, respectively [4]. The SITE study demonstrated that 35.7% of patients on mycophenolate mofetil and 38.3% of patients on methotrexate failed to achieve control of ocular inflammation [5]. Few randomised control studies have compared the efficacy of other steroid sparing therapies and biologics [1, 2, 6]. While biologics may have a more favourable side effect profile and utility as compared to traditional immunomodulatory therapies (IMT), their use can be limited by their potential side effects: increased susceptibility to infections, reactivation of latent viruses, hypersensitivity reactions, gastrointestinal disturbance, cardiac effects, and malignancy [7]. Despite the efficacy of currently available treatments for most patients, there remains a subset of patients who will require multiple trials of different IMTs to achieve remission. Janus kinases (JAK), a group of non-receptor tyrosine kinases, and signal transducer and activator of transcription (STAT), an intracellular receptor and transcription factor

FAQs

What was the study objective regarding JAK inhibitors and noninfectious uveitis?

To present a case series of eight patients with noninfectious chronic uveitis treated with upadacitinib or tofacitinib at a single institution.

How were patients selected and what was required before starting a Jakinib?

Patients were treated between 2015 and 2022, had previously failed alternative immunomodulatory therapy, had consistent ophthalmic evaluations for at least 6 months, and stayed on the Jakinib for at least 3 months.

What were the main results and side effects observed in this cohort?

Most patients achieved control, depending on whether the Jakinib was started for ocular or systemic disease control. Gastrointestinal upset was the most common side effect of tofacitinib, while upadacitinib had no reported side effects.

Sep 29, 2026

Uploaded by Maya Linwood