JAK Inhibitors Offer Some Improvement for Pediatric Uveitis

TOPLINE:

Janus kinase (JAK) inhibitors led to improvement of uveitis in approximately half of pediatric patients previously treated with disease-modifying antirheumatic drugs (DMARDs) in a case series.

METHODOLOGY:

• The researchers reported a case series from five US and Italian centers on patients under 21 years old who were treated with at least one JAK inhibitor for noninfectious uveitis, with at least 3 months of follow-up.
• Of the 27 patients, most were women (93%) and non-Hispanic (93%) and White (82%) individuals having an average age of 15 years, with 41 affected eyes involving mostly anterior uveitis (88.9%), followed by intermediate uveitis (3.7%) and panuveitis (7.4%).
• Most patients (74%) had juvenile idiopathic arthritis, and at baseline, 57% had synechiae, 50% had glaucoma, 44% had cataracts, and 33% had band keratopathy.
• All patients had previously taken DMARDs, mostly methotrexate (89%), and 66.7% had at least one complication at baseline.
• Researchers collected data at 3, 6, and 12 months of anterior chamber cells, best-corrected visual acuity, new or progressive complications, and ability to stop or taper steroids.

TAKEAWAY:

• Overall, 63% of patients received tofacitinib, 26% received baricitinib, 7% received upadacitinib, and 4% received ruxolitinib.
• About 52% of treating physicians reported that the JAK inhibitor contributed to improved uveitis disease control, but 30% did not respond or lacked 12-month data.
• At the last recorded visit, 54% of patients had inactive disease, while 34% were stable, 7% were worsening, and 5% lacked data; seven of 16 patients taking steroids at baseline ceased taking them.
• Only 22% of existing complications progressed, including 15% synechiae, 11% band keratopathy, and 4% glaucoma, plus one new cataract complication (4%).

IN PRACTICE:

“Despite inadequate response to the other DMARDs, some subjects had improved disease activity and decreased steroid requirement on JAK inhibitors,” the authors reported. “No significant decline in visual acuity was seen.”

SOURCE:

The study was presented at the Childhood Arthritis and Rheumatology Research Alliance 2025 Annual Scientific Meeting and was led by Ashley M. Cooper, MD, professor of pediatrics at the University of Missouri–Kansas City School of Medicine and director of the division of rheumatology at Children’s Mercy Kansas City in Missouri.

LIMITATIONS:

The study involved only 27 patients, although this may be the largest cohort with data on outcomes from JAK inhibitors for pediatric uveitis.

DISCLOSURES:

The authors did not report any disclosures.The authors reported no external funding source.