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Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review

Ocular disease, such as scleritis and peripheral ulcerative keratitis (PUK), may be a serious ocular complication. We present a patient with severe and refractory PUK treated with baricitinib. A review of the literature on Janus kinase inhibitors (JAKINIB) in refractory ocular surface pathology was...

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Autores principales: Calvo-Río, Vanesa, Sánchez-Bilbao, Lara, Álvarez-Reguera, Carmen, Castañeda, Santos, González-Mazón, Iñigo, Demetrio-Pablo, Rosalía, González-Gay, Miguel A., Blanco, Ricardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677317/
https://www.ncbi.nlm.nih.gov/pubmed/36419482
http://dx.doi.org/10.1177/1759720X221137126
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author Calvo-Río, Vanesa
Sánchez-Bilbao, Lara
Álvarez-Reguera, Carmen
Castañeda, Santos
González-Mazón, Iñigo
Demetrio-Pablo, Rosalía
González-Gay, Miguel A.
Blanco, Ricardo
author_facet Calvo-Río, Vanesa
Sánchez-Bilbao, Lara
Álvarez-Reguera, Carmen
Castañeda, Santos
González-Mazón, Iñigo
Demetrio-Pablo, Rosalía
González-Gay, Miguel A.
Blanco, Ricardo
author_sort Calvo-Río, Vanesa
collection PubMed
description Ocular disease, such as scleritis and peripheral ulcerative keratitis (PUK), may be a serious ocular complication. We present a patient with severe and refractory PUK treated with baricitinib. A review of the literature on Janus kinase inhibitors (JAKINIB) in refractory ocular surface pathology was also performed. For the literature review, the search in PubMed, Embase, and the Cochrane library was carried out from inception until 31 May 2021, including conference proceedings from four major rheumatology congresses. All original research articles studying JAKINIB treatment in patients with inflammatory eye disease were included. We present an 85-year-old woman with rheumatoid arthritis (RA) and secondary Sjögren’s syndrome refractory to methotrexate, leflunomide, certolizumab pegol, adalimumab, and tocilizumab (TCZ). However, 10 months after starting TCZ, the patient suffered a perforation secondary to PUK, requiring urgent surgical intervention. In the absence of infection, she was treated with boluses of intravenous methylprednisolone followed by oral prednisone at high doses in a decreasing pattern together with baricitinib at a dose of 2 mg/day with a very rapid and persistent favorable response to eye and joint symptoms. After 18 months of treatment, the patient had not presented serious side effects or signs of reactivation of her disease. In addition to this report, three other studies including one PUK associated with RA and two non-infectious scleritis treated with tofacitinib were included in this literature review. All three patients had experienced an insufficient response to conventional treatment, including biologic agents, before being switched to JAKINIB, leading to a complete or partial recovery in all of them without significant adverse effects so far. JAKINIBs (baricitinib and tofacitinib) may be an effective and safe therapy in patients with severe autoimmune and refractory ocular surface pathology, such as scleritis and PUK.
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spelling pubmed-96773172022-11-22 Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review Calvo-Río, Vanesa Sánchez-Bilbao, Lara Álvarez-Reguera, Carmen Castañeda, Santos González-Mazón, Iñigo Demetrio-Pablo, Rosalía González-Gay, Miguel A. Blanco, Ricardo Ther Adv Musculoskelet Dis Case Report Ocular disease, such as scleritis and peripheral ulcerative keratitis (PUK), may be a serious ocular complication. We present a patient with severe and refractory PUK treated with baricitinib. A review of the literature on Janus kinase inhibitors (JAKINIB) in refractory ocular surface pathology was also performed. For the literature review, the search in PubMed, Embase, and the Cochrane library was carried out from inception until 31 May 2021, including conference proceedings from four major rheumatology congresses. All original research articles studying JAKINIB treatment in patients with inflammatory eye disease were included. We present an 85-year-old woman with rheumatoid arthritis (RA) and secondary Sjögren’s syndrome refractory to methotrexate, leflunomide, certolizumab pegol, adalimumab, and tocilizumab (TCZ). However, 10 months after starting TCZ, the patient suffered a perforation secondary to PUK, requiring urgent surgical intervention. In the absence of infection, she was treated with boluses of intravenous methylprednisolone followed by oral prednisone at high doses in a decreasing pattern together with baricitinib at a dose of 2 mg/day with a very rapid and persistent favorable response to eye and joint symptoms. After 18 months of treatment, the patient had not presented serious side effects or signs of reactivation of her disease. In addition to this report, three other studies including one PUK associated with RA and two non-infectious scleritis treated with tofacitinib were included in this literature review. All three patients had experienced an insufficient response to conventional treatment, including biologic agents, before being switched to JAKINIB, leading to a complete or partial recovery in all of them without significant adverse effects so far. JAKINIBs (baricitinib and tofacitinib) may be an effective and safe therapy in patients with severe autoimmune and refractory ocular surface pathology, such as scleritis and PUK. SAGE Publications 2022-11-19 /pmc/articles/PMC9677317/ /pubmed/36419482 http://dx.doi.org/10.1177/1759720X221137126 Text en © The Author(s), 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Report
Calvo-Río, Vanesa
Sánchez-Bilbao, Lara
Álvarez-Reguera, Carmen
Castañeda, Santos
González-Mazón, Iñigo
Demetrio-Pablo, Rosalía
González-Gay, Miguel A.
Blanco, Ricardo
Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review
title Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review
title_full Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review
title_fullStr Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review
title_full_unstemmed Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review
title_short Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review
title_sort baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677317/
https://www.ncbi.nlm.nih.gov/pubmed/36419482
http://dx.doi.org/10.1177/1759720X221137126
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