Upadacitinib in Refractory Vogt–Koyanagi–Harada Disease: A Case Report

PURPOSE: To evaluate the role of Upadacitinib, a selective Janus kinase-1 (JAK-1) inhibitor, in the management of refractory Vogt-Koyanagi-Harada (VKH) disease. METHODS: A 25-year-old male was diagnosed with bilateral VKH disease based on clinical findings and supportive investigations. He experienced multiple recurrences despite treatment with conventional therapies, including systemic corticosteroids, cyclosporine, mycophenolate mofetil (MMF), and adalimumab. The patient also demonstrated intolerance to systemic steroids. He was subsequently classified as having refractory VKH in both eyes and was initiated on oral Upadacitinib. RESULTS: Following the initiation of oral Upadacitinib, a novel selective JAK-1 inhibitor, there was complete resolution of subretinal fluid (SRF), with no further recurrences observed during follow-up, resulting in sustained disease stability. CONCLUSION: This case underscores the potential utility of selective JAK-1 inhibition in the management of refractory VKH disease, particularly in patients who are unresponsive to or intolerant of conventional corticosteroid and immunosuppressive therapies.