Early versus late immunomodulatory therapy in Vogt-Koyanagi-Harada disease

Abstract

Purpose: To evaluate early versus late immunomodulatory therapy (IMT) for patients following initial diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Methods:Retrospective review including all VKH patients seen 5/1/2014 to 4/1/2016 at LAC+USC. Early IMT was defined as starting an immunomodulatory agent within 3 months of corticosteroid initiation.Results: Twenty-seven patients were included, of whom 15 received early IMT and 8 received late IMT.Early IMT patients trended toward greater improvement in vision compared to late IMT (logMAR 0.59 vs. 0.11; p=0.14) with no differences in ocular complications including ocular hypertension (p=0.53) and cataract (p=1.0). Patients receiving early IMT averaged 0.93 recurrences versus 2.13 recurrences for late IMT (p=0.092). Of patients successfully taper off oral corticosteroids, the early IMT group was tapered in an average of 8.3 months versus 19.8 months for late IMT (p=0.0019). Conclusions:Early IMT in VKH may allow for shorter duration of corticosteroids with similar visual outcomes, ocular complications, and disease recurrences.

Vogt-Koyanagi-Harada Disease (Uveomeningitic Syndrome)

“…Case series have demonstrated that multiple regimens may be effective in controlling disease progression and reducing recurrence in patients who are poorly responsive or intolerant of steroids [58][59][60]. However, data are mixed as to whether starting these therapies initially may confer a superior visual outcome or reduced complications as compared to those initially treated with steroids alone and then switched to IMT [61]. Newer biologic agents such as infliximab, adalimumab, rituximab, and interferon alpha for the treatment of VKH have been described in case reports only [62][63][64].…”