Tofacitinib for Refractory Non-Infectious Ocular Inflammation: A Retrospective Observational Study.

Abstract

Purpose: To evaluate the clinical indications, effectiveness, and cost implications of tofacitinib in refractory non-infectious ocular inflammation.

Methods: This retrospective study included 60 patients treated with tofacitinib at a tertiary eye care centre in South India, between January 2020 and January 2026. Data collected included demographics, anatomical/etiological diagnoses, prior immunomodulation, indications, treatment regimen, adverse events of tofacitinib, and duration of follow-up. Ocular inflammatory flares before and after tofacitinib were quantified and expressed as incidence rates/1,000 person-months. Incidence-rate-ratios were estimated using Poisson regression with log person-months as an offset. A descriptive cost and exploratory cost-effectiveness analysis was performed.

Results: Mean age: 43.5 ± 13.8 years; 61.7% were female. Tofacitinib was initiated for recurrent ocular inflammation in 91.7%. Median duration of tofacitinib therapy: 11 months (range: 6-24). Number of ocular inflammatory flares decreased from 263 before tofacitinib to 34 after tofacitinib. The incidence rate declined from 275.1 to 47.5 episodes/1,000 person-months, corresponding to a significant reduction in flare incidence (p<0.001), representing approximately an 83% reduction. A greater proportion of patients achieved better visual acuity at final follow-up(p = .0001). Adverse events occurred in 13.8% of patients, commonly dyslipidaemia. A total of 229 flares were prevented, with an estimated cost-per-flare avoided of approximately ₹7,200 (76 USD). Among patients switched from mycophenolate-mofetil/adalimumab, tofacitinib therapy was associated with an average cost saving of ₹79,369/ patient and ₹9,458/ patient-month.

Conclusions: Tofacitinib was associated with a significant reduction in ocular flares and improvement in visual outcomes in patients with refractory non-infectious ocular inflammation. These findings suggest that JAK inhibition may represent an effective and economically viable therapeutic option for selected patients with difficult-to-treat ocular inflammatory disease.