Earlier immunomodulatory treatment is associated with better visual outcomes in a subset of patients with Vogt‐Koyanagi‐Harada disease

Abstract

ABSTRACT.Purpose: To evaluate clinical outcomes of first-line immunomodulatory therapy (IMT) and prednisone alone or late IMT in Vogt-Koyanagi-Harada disease. Methods: Retrospective cohort study of 152 patients with Vogt-KoyanagiHarada disease evaluated in a referral uveitis clinic in Chile from 1985 to 2011. Medical records of these patients were reviewed. Demographic data, clinical evaluation, type of treatment, functional outcomes, glucocorticoid (GC) dose and complications were recorded. Multivariate logistic regression was used to identify prognostic factors of poor response to GC. Results: There were no significant differences between first-line IMT group and prednisone alone/late IMT group in terms of visual acuity (VA) improvement, complications and GC sparing effect. There was a trend for a higher frequency of systemic adverse effects leading to discontinuation of treatment in patients receiving IMT than in those receiving prednisone (14.6% and 6.5%, respectively). The subgroup of patients with poor response to GC who showed functional improvement had a significantly earlier time to IMT initiation than the patients who had no improvement. We identified following prognostic factors of poor response to GC: VA ≤20/200, fundus depigmentation, chronic disease and tinnitus at diagnosis. Patients with a prognostic factor (excluding tinnitus) and VA improvement had an earlier IMT initiation than those who had worse functional outcome. Conclusion: There were no differences in outcomes between first-line IMT and prednisone alone/late IMT in the entire VKH group. However, in a subset of patients, there was a significant better functional outcome with earlier IMT initiation.

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

“…Most studies of VKH suggest a female preponderance. [16][17][18][19][20] In concordance with the published literature, we found that 111 (72.1%) of the patients were females. However, Read et al 16 found no significant differences in gender among various ethnic groups, with 67% of the study cohort being female.…”

“…The age at onset of VKH disease seems to be highly variable, with a peak in the third and fourth decades of life. [20][21][22] The mean age at presentation in our study (33.8 ± 13 years) is similar to that reported for other studies. [20][21][22] Children are rarely affected, with reports estimating that pediatric cases constitute approximately 1-3% of all cases.…”

“…[20][21][22] The mean age at presentation in our study (33.8 ± 13 years) is similar to that reported for other studies. [20][21][22] Children are rarely affected, with reports estimating that pediatric cases constitute approximately 1-3% of all cases. 23,24 In our series, only seven (4.5%) patients were 16 years of age or younger at presentation, which concurs with previous reports.…”

“…In accordance with these results, we noted better visual outcomes in patients with VKH disease treated with corticosteroid plus CSP or MMF as first-line treatment compared with patients who were treated with OP plus AZT or MTX. Conversely, a recent report by Urzua et al 20 shows a poor functional response in a subgroup of patients with VHK disease, who were treated with cyclosporine compared with other immunomodulatory agents. However, those authors 20 refer that this subgroup is too small for analysis (only three out of five patients treated with CSP had a poor response).…”

Vogt−Koyanagi−Harada disease

“…The use of immunomodulatory therapy is associated with a reduced risk of vision loss in eyes with VKH [2]. Numerous different medications and classes of immunomodulatory therapy have been used, from the more classic antimetabolites and T-cell inhibitors, to the newer, biologic agents [39]. One of the newest agents used to treat this disease is rituximab, a monoclonal antibody against CD20.…”