Evaluation of the effectiveness and safety of upadacitinib in the treatment of idiopathic refractory anterior scleritis: A case series study

Abstract

The treatment of refractory anterior scleritis could be challenging with some patients not responding to conventional therapies such as systemic corticosteroid and immunosuppressive agents. The purpose of this study was to evaluate the effectiveness and safety of upadacitinib, a selective Janus kinase inhibitor (JAK-i), in the treatment of idiopathic refractory scleritis. Five patients with idiopathic refractory anterior scleritis and no concomitant systemic immune diseases, who failed to respond to systemic steroid and immunosuppressants were included in this study. All the patients experienced multiple reoccurrences ranging from 7 to 12 times per year before JAK-i therapy. After exclusion of systemic infectious diseases and other organ dysfunction, they were initiated with oral upadacitinib 15mg daily and scleral inflammation and relapses as well as safety profile were assessed. After the initiation of oral upadacitinib therapy (range, 2-12 months), all the patients achieved alleviated scleral inflammation and reduced relapse rates with three patients undergoing complete remission. No significant side effects were noted in all the five patients during the whole treatment period. In conclusion, upadacitinib could be an effective and safe option for refractory anterior scleritis in short term with a steroid sparing benefit. Further studies are required to assess the efficacy and safety profile for upadacitinib in a larger sample size and longer observation time.