Therapeutic Potential of Upadacitinib in Adolescents with Idiopathic Chronic Panuveitis Who Lost Response to Adalimumab.

Purpose: This report highlights the administration of upadacitinib in four adolescents with idiopathic chronic refractory panuveitis who showed an inadequate response to systemic glucocorticoids, immunosuppressive agents, and anti-TNF biologic therapy.

Methods: We present four cases: two 13-year-old boys, one 15-year-old boy, and one 14-year-old girl, each with a history of idiopathic panuveitis that persisted for 4, 8, 4, and 5 years, respectively.

Results: Upadacitinib effectively reduced ocular inflammation in all four cases during the first month of treatment. Following upadacitinib treatment, adalimumab was discontinued or extended, and the immunosuppressive agents were gradually tapered. In two cases, it led to complete resolution of the anterior segment and vitreous inflammation and significant improvement in the posterior segment. However, two patients developed upper respiratory tract symptoms at the second and fifth months, respectively, both of which were associated with recurrence of ocular inflammation and required high-dose glucocorticoids for control. No other serious adverse events were documented in the four patients during the nine to ten months follow-up period.

Conclusions: These cases indicate that upadacitinib may be an effective treatment strategy for adolescents with idiopathic chronic refractory panuveitis. However, the potential risk of infections should be considered and monitored.