Comparison of the Clinical Efficacy of Two Different Immunosuppressive Regimens in Patients with Chronic Vogt-Koyanagi-Harada Disease

Abstract

Both regimens showed a good clinical efficacy, but CyA seems to be a better glucocorticoid-sparing agent than AZA.

Clinical Outcomes of Patients with Vogt–Koyanagi–Harada Disease Over 12 Years at a Tertiary Center

“…19,[32][33][34] In addition, IMT with azathioprine, 35 19 reported that the use of immunosuppressive drug therapy was associated with a risk reduction of 67% for vision loss to 20/50 or worse in better-seeing eyes and of 92% for vision loss to 20/200 or worse in better-seeing eyes.…”

Vogt-Koyanagi-Harada Disease

“…[1][2][3][4][5][6] While corticosteroids are the mainstay of therapy and are required to control active inflammation during episodes of acute or recurrent inflammation, cumulative evidence supports the first-line use of corticosteroid-sparing immunosuppressive agents to reduce the risk of recurrence, decrease the development of late complications, and improve long-term vision. [16][17][18][19][20] Multimodal imaging studies, particularly fluorescein angiography and spectral domain-ocular coherence tomography (SD-OCT), are important adjuncts for initial diagnosis and early monitoring of treatment response. 5 Indocyanine green angiography (ICGA) appears to be especially useful for detecting suboptimal or incomplete control of choroidal inflammation in patients with longstanding or chronic/recurrent disease.…”

Chronic Recurrent Vogt–Koyanagi–Harada Disease and Development of ‘Sunset Glow Fundus’ Predict Worse Retinal Sensitivity

“…32 There is accumulating evidence to suggest that despite proper treatment with corticosteroid monotherapy, many patients develop chronic, recurrent granulomatous inflammation and progressive depigmentation of the fundus, resulting in 'sunset glow fundus' appearance even after the clinical disease appears to be under control. 6,9,[15][16][17][18][19] Recently, Sakata et al 18 demonstrated that in spite of early high-dose corticosteroid therapy, 79% of patients with VKH disease progressed to chronic recurrent disease. In previous studies, we demonstrated that addition of immunomodulatory therapy with mycophenolate mofetil and cyclosporine as first-line therapy combined with systemic corticosteroids in patients with initial-onset acute VKH disease leads to significant reduction in recurrences of uveitis and development of complications and 'sunset glow fundus' suggesting that immunomodulatory therapy was effective in controlling progressive subclinical choroidal inflammation.…”

“…7,13 However, despite appropriate treatment with corticosteroid monotherapy, many patients develop chronic recurrent granulomatous inflammation and progressive depigmentation of the fundus, resulting in 'sunset glow fundus' appearance even after the clinical disease appears to be under control. 6,9,[15][16][17][18][19] Several studies suggested that the use of non-steroid immunomodulatory therapy with mycophenolate mofetil, cyclosporine, azathioprine, and methotrexate as firstline therapy in addition to corticosteroids early in the course of the disease, is associated with good clinical results. 11,14,16,20,21. Macular function of patients with VKH disease is usually tested by best-corrected visual acuity (BCVA) assessment as the primary endpoint to identify predictive factors for final outcome and to measure the effectiveness of therapies.…”