The outcomes of mycophenolate mofetil therapy combined with systemic corticosteroids in acute uveitis associated with Vogt–Koyanagi–Harada disease

Abstract

. Purpose: To study the effectiveness of mycophenolate mofetil (MMF) as first‐line therapy combined with systemic corticosteroids in acute uveitis associated with Vogt–Koyanagi–Harada (VKH) disease. The outcomes in this group were compared with those of another group of patients with VKH disease who were treated with corticosteroid monotherapy or with delayed addition of immunomodulatory therapy. Methods: This prospective study included 19 patients (38 eyes) diagnosed with acute uveitis associated with VKH disease. Results: The mean follow‐up period was 27.0 ± 11.1 months (range 16–54 months). Corticosteroid‐sparing effect was achieved in all patients. The mean interval between starting treatment and tapering prednisone to 10 mg or less daily was 5.1 ± 1.2 months (range 3–7 months). Ten (53%) patients discontinued treatment without relapse of inflammation. The mean time observed of treatment was 17.3 ± 11.9 months (range 3–41.5 months). Visual acuity of 20/20 was achieved by 38% of the eyes in the corticosteroid group and by 74% in the corticosteroid + MMF group (p < 0.001). Recurrent inflammation of ≥3 times was reduced significantly (p = 0.0383) in the corticosteroid + MMF group (3%) as compared to corticosteroid group (18%). Development of all complications was significantly higher in the corticosteroid group (43%) compared with the corticosteroid + MMF group (8%) (p < 0.001). None of the eyes in the corticosteroid + MMF group developed ‘sunset glow fundus’. Conclusions: Addition of MMF as first‐line therapy to corticosteroids in patients with acute uveitis associated with VKH disease leads to significant reduction in recurrences of uveitis and development of late complications and significantly improves visual outcome.

Outcomes of Vogt-Koyanagi-Harada Disease: A Subanalysis From a Randomized Clinical Trial of Antimetabolite Therapies

“…21–23 Some studies suggest that using immunosuppressive therapy (IMT) along with corticosteroids results in better visual outcomes compared to using corticosteroids as monotherapy or with delayed addition of immunosuppressants. 16,17 Overall, VKH studies have had varied results, and prospective studies comparing IMT are incredibly scarce. There are several drawbacks to retrospective and non-randomized prospective studies, such as indication bias.…”

Outcomes of Trabeculectomy With Mitomycin-C in Uveitis Associated With Vogt-Koyanagi-Harada Disease

“…Such incidence could probably be reduced by using immunomodulatory therapy to achieve better control of inflammation and reduce vision-threatening complications occurring in the chronic, recurrent phase of VKH. 16 The IOP and number of antiglaucoma medications decreased significantly throughout the follow-up period.…”

A systematic approach to emergencies in uveitis

“…A topical steroid such as prednisolone acetate 1% is recommended for anterior uveitis. A prospective study of mycophenolate mofetil combined with systemic corticosteroids for acute uveitis reported statistically significantly lower recurrent inflammation and a 35% lower incidence of complications with combined therapy versus corticosteroid monotherapy 37. The authors of this study concluded that combined therapy as initial therapy reduced the recurrence of uveitis and significantly improved visual outcome 37…”

“…The prevalence of uveitis seems to differ in different regions of the world 37. This difference is partially due to the pathogens in the region 43.…”