Baricitinib: An Alternative Treatment For Refractory Cases Of Ocular Cicatricial Pemphigoid.

To present a case of severe dry eye syndrome due to ocular cicatricial pemphigoid refractory to conventional treatment.

Case description: A 72-year-old female patient consulted for pain and discomfort in both eyes for two months. She had no relevant ophthalmological history. 

Biomicroscopy showed conjunctival hyperemia, whitish scars in the fornices, shortening of the fornices, and  a neurotrophic ulcer in the right eye. A cryopreserved amniotic membrane was placed and a conjunctival biopsy was performed, the result of which reported ocular cicatricial pemphigoid.  A consultation with the immunology service was carried out and it was decided to start oral immunosuppressive therapy with Meprednisone and Mycophenolate Mofetil. She received three monthly cycles of IV Rituximab, after which conjunctival inflammation persisted, for which reason 3 pulses of IV cyclophosphamide were indicated. In ophthalmological controls, signs of activity and progression of inflammation were observed. 

 After a second cycle of 3 IV cyclophosphamide pulses without achieving significant changes, it was decided to start with Baricitinib 4 mg every other day, a drug that inhibits the Janus kinase enzyme (JAK), which blocks the JAK1 and JAK2-STAT signaling pathway and inhibits interleukin 6 (IL-6), interleukin 12 (IL-12) and interleukin 13 (IL-23). ​​These molecules are increased in patients with ocular cicatricial pemphigoid.With no evidence of disease progression, the patient reports symptomatic improvement.

Conclusion: in cases of ocular cicatricial pemphigoid refractory to conventional immunosuppressive treatment, the drug Baricitinib may be an alternative therapeutic option. It is currently approved by the FDA for the treatment of rheumatic diseases with an immunological basis.