Clinical Outcomes of Upadacitinib in Refractory Noninfectious Scleritis

PURPOSE: To evaluate the effectiveness and safety of upadacitinib in reducing corticosteroid dependence and controlling relapse rate in patients with refractory noninfectious scleritis. METHODS: A retrospective real-world study. Patients with refractory noninfectious scleritis treated with upadacitinib between January and December 2025 were included. Medical records were retrospectively reviewed. The primary outcome was sustained clinical remission, defined as absence of active scleral inflammation maintained for at least 2 consecutive visits separated by a minimum interval of 28 days. Secondary outcome is the relapse rate. RESULTS: A total of 14 patients were included. After a median follow-up period of 8.0 months, 13 of 14 patients (92.9%) achieved absence of active scleral inflammation. The median time from upadacitinib initiation to first attainment of remission was 3.0 months (IQR, 2.0-4.0 months). A total of 3 patients (21.4%) experienced relapse. Systemic glucocorticoid use was reduced from baseline level of 14.5 mg/day to 5.0 mg/day at last follow-up. Of the 12 patients receiving systemic glucocorticoids at baseline, 4 discontinued them; 6 patients in total were glucocorticoid-free at the last follow-up. One patient developed elevated blood pressure, and no serious adverse events were observed. CONCLUSION: Upadacitinib provides a safe treatment option in reducing the chances of corticosteroid dependence and controlling the relapse rate in refractory noninfectious scleritis.