Ibrutinib-related uveitis: A case series

Abstract

Purpose: Four cases of ibrutinib-related uveitis are presented, which are to the best of our knowledge the first in the literature. Possible mechanisms of ibrutinib-mediated uveitis are explored.

Observations: Case 1 is a 60-year-old female who had been stable on 1 year of ibrutinib for chronic lymphocytic leukaemia. She was diagnosed with ibrutinib-related uveitis, which responded well to topical steroids. Case 2 is a 63-year-old male diagnosed with uveitis after 2 years of ibrutinib treatment for chronic lymphocytic leukaemia. He responded well to topical and oral steroids; however, he continued to have uveitis relapses after weaning steroids. Case 3 is a 69-year-old male diagnosed with uveitis after 18 months of ibrutinib treatment. He was trialed on topical and intravenous steroids, and restarted ibrutinib without worsening of symptoms. Case 4 is a 66-year-old female who developed uveitis after being stable on ibrutinib for 3 years. She responded well to topical steroids.

Conclusions and importance: Inflammatory complications of tyrosine kinase inhibitors are well described. While ibrutinib, and other kinase inhibitors, are generally well-tolerated, there are increasing reports of ocular toxicities, including uveitis. It is recommended to monitor patients for potential ocular adverse effects and facilitate rapid ophthalmologic assessment.

Keywords: Ibrutinib; Kinase inhibitors; Ocular toxicity; Oral chemotherapy; Uveitis.

Fig. 1

Case 1 – OCTsThe OCTs after weaning steroids (5 months post commencement) demonstrates a relapse with significant cystoid macular oedema on the right (A). The left eye OCT shows cystoid macular oedema with an epiretinal membrane (B). 5 months after re-commencing topical steroids, OCTs demonstrate resolved cystoid macular oedema on the right (C) and left (D).

Fig. 2

Case 2 – Anterior Segment (Initial Presentation) Clinical photograph of the right eye on initial presentation, demonstrating a single posterior synechia and keratic precipitates in the inferior cornea.

Fig. 3

Case 2 – Posterior Segment (Initial Presentation) The fundal photograph of the right eye demonstrates global papilloedema with blurred optic nerve edges and elevation, worse on the right (A) than left (B). OCTs demonstrate optic nerve head oedema, worse on the right (C) than left (D).

Fig. 4

Case 2 – OCTs (8 Months of Steroid Therapy) After 8 months of steroid therapy, OCTs demonstrate markedly less optic disc oedema on the right (A) and left (B).