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Case Report in CLL: Is Sclerouveitis an Off-Target Effect of Ibrutinib Treatment?

By: Susan Reckling
Posted: Monday, March 8, 2021

Currently, little is known about the ocular adverse events that may accompany ibrutinib's use in the treatment of chronic lymphocytic leukemia (CLL). However, Todd Urton, MD, of Queen’s University, Kingston, Ontario, Canada, and colleagues attempted to shed some light on such potential off-target effects through the presentation of a case of vision-threatening sclerouveitis in a man who had received this Bruton’s kinase inhibitor for CLL for nearly 1 year. Details of their case report were published in Ocular Immunology and Inflammation.

“Physicians should consider ophthalmic consultation and/or screening of their high-risk patients placed on ibrutinib due to the increasing number of reports of ocular adverse events associated with this medication,” the authors proposed.

In July 2017, a 67-year-old man was started on 420 mg of ibrutinib for CLL. His ocular history was notable for blurry vision bilaterally, laser in situ keratomileusis (LASIK) surgery a decade before, and high intraocular pressure (being managed with a topical beta-blocker). In June 2018, he was referred to the authors’ ophthalmology clinic for bilateral blurry vision. Ocular examinations suggested a diagnosis of undifferentiated bilateral acute anterior uveitis, and topical corticosteroid and cycloplegic drops were prescribed.

At 4 months’ follow-up, the patient presented with a focal injection area and chemosis in his left eye, extending temporally to the lacrimal gland. After other tests, a biopsy was performed, which showed scar tissue with fibrosis and focal chronic inflammation. One month after the biopsy, the patient reported his dose of ibrutinib had been reduced to 140 mg daily. The patient continues to use maintenance corticosteroid eye drops and is being monitored for future uveitic episodes.

“Additional basic science investigations using in vitro models are required to shed light on off-target effects of ibrutinib as well as its immunoregulatory properties, given the correlation observed between CLL remission and uveitis induction,” the authors concluded.

Disclosure: The study authors reported no conflicts of interest.

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