Uveitis: contrasting the approaches in Japan and the United States

Background: The common presence of human leukocyte antigen (HLA)-DRB1*04 in Vogt-Koyanagi-Harada (VKH) disease is well known. The aim of this study was to investigate the relationship between visual prognosis and HLA-DRB1*04 alleles during systemic corticosteroid therapy in patients with VKH disease. Methods: This retrospective case series included 57 eyes from 29 consecutive patients with treatment-naïve VKH disease who received systemic corticosteroid therapy. Visual acuity, sex, refractive error, central retinal thickness (CRT), central choroidal thickness (CCT), and duration from onset to treatment were measured at initial and final visits. Mean values of parameters were compared with each visit. Genotyping was performed by polymerase chain reaction amplification with sequence-specific primer. Results: Linear regression showed significant differences in logMAR best-corrected visual acuity between the three groups of homozygotes, heterozygotes, and normal subjects at baseline ( p <0.01), at three months after treatment ( p <0.01).There was no significant differences at six months after treatment ( p =0.257). No significant differences were detected between the three groups in age, sex, refractive error, CRT, CCT, or duration from onset to treatment. Conclusion: Alleles of HLA-DRB1*04 might affect visual prognosis and be related to early response after initiation of treatment in VKH disease.

show abstract

“…For these reasons, steroid-centered treatment has always been used. But future treatments for recurrent VKH may be different [14].…”

Section: Discussionmentioning

confidence: 99%

Correlation between visual acuity and human leukocyte antigen (HLA)-DRB1*04 in patients with Vogt-Koyanagi-Harada disease

Misawa

Tagami

Kohno

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Uveitis cases are frequently encountered in medical practice. In Japan, as in the United States, a step wise approach to its treatment is commonly employed [3]. Most cases of uveitis are treated with topical steroid treatment, more particularly with eye drops.…”

Section: Introductionmentioning

confidence: 99%

“…However, some patients do not respond to topical treatment, in which case they are referred to hospitals for further investigation and treatment. Especially in severe Behçet disease, Japanese ophthalmologists move directly to biological drugs such as infliximab [3]. In the hospital, these patients undergo clinical tests such as blood tests and chest X-rays in order to investigate the cause of uveitis.…”

Section: Introductionmentioning

confidence: 99%

“…In Japan, the only immunosuppressive drug approved for uveitis treatment is CSA. Methotrexate (MTX) and other immunosuppressive drugs are not approved for the treatment of uveitis in Japan [3]. Using immunosuppressive drug to treat uveitis is also not approved by the Food and Drug Administration in the USA.…”

Section: Introductionmentioning

confidence: 99%

“…However, it is worth noting that the insurance system in Japan is different from US. If an insured patient requires expensive immunosuppressive medication, the insurer will often need to approve its use [3]. Therefore, in comparison with the USA, there few options available in Japan for controlling inflammation in patients with uveitis.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Current standardized therapeutic approach for uveitis in Japan

Maruyama

2019

Immunological Medicine

View full text Add to dashboard Cite

Uveitis is an ocular disease associated with systemic immune-mediated diseases such as rheumatoid arthritis, inflammatory bowel disease and ankylosing spondylitis; and infectious diseases. Infectious uveitis occasionally shows symptoms similar to those of non-infectious uveitis. Therefore, distinguishing between non-infectious and infectious uveitis is critical for definitive diagnosis and appropriate choice of treatment. Once the cause of infection is known, treatment can be promptly initiated. However, in contrast to infectious uveitis, noninfectious uveitis is more difficult to diagnose clinically. Eliminating the possibility of infectious uveitis is important because unlike the infectious type, non-infectious uveitis is treated with immunosuppressive drugs such as corticosteroids and biological agents. Compared to other countries, the drugs available in Japan are limited. Cyclosporin A is the only immunosuppressive drug available for treating uveitis in Japan, and infliximab and adalimumab are the only biological drugs that have been approved for use in the treatment of uveitis in Japan. In this review, I describe the characteristics of typical non-infectious uveitis in Japan and its treatment methods.

show abstract