Effects of the duration of initial oral corticosteroid treatment on the recurrence of inflammation in Vogt-Koyanagi-Harada disease

Abstract

Purpose To evaluate the effects of the duration of oral corticosteroid treatment on the recurrence of inflammation in Vogt-KoyanagiHarada (VKH) disease. Methods Retrospective analysis of 35 VKH patients who received oral corticosteroid during the first attack of VKH with a minimum followup of 6 months. Patients were divided into two groups on the basis of the oral corticosteroid treatment duration of less than 6 months or 6 months or more. Kaplan-Meier survival and Cox-regression analyses were carried out to compare the recurrence rates of inflammation in the two groups. Results The mean age of onset was 42.5 years and the mean follow-up duration was 3.6 years. During the follow-up period, 10 (58.8%) of the 17 patients who received oral corticosteroid for less than 6 months compared with 2 (11.1%) of the 18 patients who had treatment for 6 months or more developed recurrence of inflammation (P ¼ 0.003). Coxregression analysis showed that the duration of oral corticosteroid treatment for less than 6 months was the only significant risk factor for recurrence of VKH after adjustment for age, gender, and the initial dosage of oral corticosteroid treatment (adjusted odds ratio ¼ 8.8, P ¼ 0.008). Patients who received oral corticosteroid treatment for less than 6 months were also more likely to have one eye with visual acuity of 20/200 or worse (P ¼ 0.016). Conclusions Early withdrawal of oral corticosteroid is associated with increased risk of recurrence of VKH and worse visual prognosis. Oral corticosteroid should be tapered off slowly and maintained for at least 6 months for the treatment of acute VKH.

Vogt-Koyanagi-Harada Syndrome in a Healthy African-American Woman: Case Report and Review of Literature

“…Their findings were adjusted for age, gender, and initial oral dose of corticosteroid. They also found that those with the more rapid taper were more likely to have poorer visual outcomes [13]. Our patient was tapered off of prednisone over a 6 month period and has remained free of recurrence without need for further immunosuppression.…”

“…Our patient was tapered off of prednisone over a 6 month period and has remained free of recurrence without need for further immunosuppression. Lai et al [13] did not describe specifics of the steroid regimen implemented in their study nor the speed of the taper each month. In the setting of long-term steroid use, we recommend collaboration with the patient's primary care doctor to help monitor potentially serious side effects of corticosteroid use.…”

Catching the therapeutic window of opportunity in early initial-onset Vogt–Koyanagi–Harada uveitis can cure the disease

“…SGF developed in 67.6% of patients, and the mean duration before SGF appearance was 4.2 ± 2.7 months. Lai et al [23] similarly demonstrated SGF development in 51.4% of patients who received oral corticosteroids during their first attack of VKH disease. These data represent substantial evidence indicating that systemic corticosteroid monotherapy cannot control progressive subclinical choroidal inflammation in most cases, even when given shortly after onset of the disease.…”

Characteristics and Prognosis of Hearing Loss Associated with Vogt-Koyanagi-Harada Disease

“…Clinicians should balance the benefits of uveitis control with the risk of side effects [Lai et al, 2009]. Although several reports have demonstrated the effectiveness of high-dose systemic corticosteroids for the ocular and neurologic manifestations of VKH disease [Solaro and Messmer Uccelli, 2000], no study has specifically examined the effectiveness of systemic steroids for the otologic manifestations.…”

“…Treatment of VKH disease is based on the early administration of high-dose systemic corticosteroids, followed by gradual tapering and maintenance for at least 6 months, and this regimen is associated with less intraocular inflammation, a decreased frequency of ocular recurrences and dermatologic features, and better visual outcomes [Rubsamen and Gass, 1991;Moorthy et al, 1995;Mondkar et al, 2000;Chee et al, 2009;Lai et al, 2009]. Clinicians should balance the benefits of uveitis control with the risk of side effects [Lai et al, 2009].…”