JAK Inhibitors in Refractory Idiopathic Uveitis or Associated With Immune-Mediated Inflammatory Diseases: A Multicenter Case Series and Literature Review of Real-World Clinical Practice

Purpose To assess the effectiveness and safety of Janus kinase inhibitors (JAKi) in patients with idiopathic or immune-mediated inflammatory diseases (IMID)-associated non-infectious uveitis (NIU) refractory to conventional therapy, and to synthesize available observational evidence.Methods We conducted a multicenter observational study including 29 patients with refractory NIU treated with JAKi. Clinical variables assessed included best corrected visual acuity, anterior chamber cell count, and macular thickness, monitored from baseline up to 3 years. A systematic review of PubMed and Embase (inception to July 30, 2025) was performed to identify reports of JAKi in NIU.Results Twenty-nine patients (median age 38 years) were included. Spondyloarthritis was the most frequent underlying IMID (n = 14). Anterior uveitis predominated (n = 17), with bilateral involvement (n = 20). Methotrexate was the most commonly immunosupressant (IS) administered (62.1%). Prior to JAKi initiation, a median of 2 biologic agents [IQR 1–3.25] had been used, mainly adalimumab and infliximab. Upadacitinib and tofacitinib were the most prescribed JAKi (n = 13 each). Remission was observed in 22 patients. Literature review identified 104 patients. Juvenile idiopathic arthritis and idiopathic uveitis were common. Tofacitinib was the most frequently used JAKi, with improved data. No serious adverse events were reported.Conclusions Observational data suggests that JAKi may be a safe and effective option in clinical practice for NIU refractory to IS and biological agents.