Vogt–Koyanagi–Harada disease: recurrence rates after initial-onset disease differ according to treatment modality and geographic area

Herbort, Carl P.; Tuğal-Tutkun, İlknur; Khairallah, Moncef; Asrar, Ahmed M. Abu El; Pavésio, Carlos; Soheilian, Masoud

doi:10.1007/s10792-020-01417-1

Cited by 15 publications

(21 citation statements)

References 61 publications

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“…To the best of our knowledge, this study includes the largest series of patients with VKH who were treated with ADA and MTX combination therapy. According to a previous study conducted in Japan, ∼61% of patients receiving systemic corticosteroid monotherapy eventually developed sunset glow fundus (5,14,(22)(23)(24)(25). Thus, if the goal of successful treatment is preventing the onset of late-stage disease, there is a risk of over-treatment in onethird of patients if steroid-sparing immunosuppressive therapy is administered at the initiation of systemic corticosteroid therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The higher recurrence rate in the MTX group may be associated with the insufficient MTX dose, which had been adjusted because of side effects. Furthermore, regardless of the concurrent initiation of MTX with systemic corticosteroid treatment, its effects were not apparent until a few months after administration, unlike immediate-acting agents such as CsA and ADA ( 14 ). Thus, the use of delayed-acting agents such as MTX alone may be inappropriate to prevent ongoing subclinical choroidal inflammation in patients with early-stage VKH.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, if the goal of successful treatment is preventing the onset of late-stage disease, there is a risk of over-treatment in one-third of patients if steroid-sparing immunosuppressive therapy is administered at the initiation of systemic corticosteroid therapy. However, when the consequences of late-stage disease (e.g., cataract, glaucoma, contrast sensitivity, color vision deficits, and extraocular complications) are weighed against the potential side effects of steroid-sparing immunosuppressive therapy, early ADA or ADA and MTX combination may be appropriate, especially in younger patients ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics and Efficacy of Adalimumab and Low-Dose Methotrexate Combination Therapy in Patients With Vogt–Koyanagi–Harada Disease

2022

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This retrospective study investigated the clinical characteristics and efficacy of adalimumab and low-dose methotrexate combination therapy in patients with Vogt–Koyanagi–Harada disease who were treated at Hiroshima University from February 2012 to May 2021. The patients' demographics, clinical features at administration of immunosuppressive therapy, steroid-sparing immunosuppressive therapy, side effects, and relapses were recorded. The efficacies of steroid-sparing immunosuppressive therapy (methotrexate, cyclosporine A, adalimumab, and adalimumab and methotrexate combination therapy) were analyzed. Among 62 patients, the median age at diagnosis was 47 years and the median duration of uveitis was 51 months. Systemic corticosteroid therapy was administered to 93.5% of patients (n = 58). Thirty-four patients (54.8%) were treated with steroid-sparing immunosuppressive therapy. Methotrexate and cyclosporine A were administered to 12 and 22 patients, respectively; relapse occurred in 50.0% and 22.7% of the patients, respectively. Discontinuation of cyclosporine A was required in 63.6% of patients because of side effects. Adalimumab was administered to 14 patients. Recurrence occurred in 11 patients, requiring methotrexate concomitantly. The mean dose of methotrexate at inflammatory quiescence after side effect-related dose decrease was 8.0 mg/week (0.13 mg/kg). The median duration of combination therapy without recurrence was 20 months. There were no serious adverse events during adalimumab therapy. A high relapse rate was observed in patients receiving methotrexate; a high rate of side effects requiring discontinuation was observed in patients receiving Cyclosporine A. Patients with late-stage Vogt–Koyanagi–Harada disease may achieve better control with adalimumab and methotrexate combination therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics and Efficacy of Adalimumab and Low-Dose Methotrexate Combination Therapy in Patients With Vogt–Koyanagi–Harada Disease

2022

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“…The optimal management of acute VKH with a combination of systemic corticosteroids and a nonsteroidal immunosuppressive agent is critical for avoiding disease progression to the chronic recurrent phase, which may occur in up to two-thirds of patients [ 21 ]. Disease progression, recurrence of inflammation, and complication development may be avoided if prompt and adequate treatment is started within three weeks of symptoms onset [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for secondary Glaucoma in patients with Vogt-Koyanagi-Harada disease

Alvarez-Guzman

Hartleben-Matkin²,

Ruiz-Lozano

et al. 2022

J Ophthal Inflamm Infect

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Background/purpose Identify the prevalence and risk factors for secondary glaucoma among Mexican-mestizo patients with Vogt-Koyanagi-Harada Disease (VKH). Methods Retrospective cohort study analyzing the demographic, clinical, and epidemiological variables. Risk estimates were calculated using a Cox proportional hazards regression model. Results One hundred eyes of 50 patients, 44 (88%) women and 6 men (12%) with a median age of 35.5 years (IQR 29–46) and a median follow-up time of 72 months (IQR 13.7–126.7) were analyzed. The prevalence of glaucoma was 20%, with angle-closure accounting for 70% of all cases. Significant clinical risk factors for glaucoma development were a chronic recurrent stage at presentation (RR 2.88, 95% CI 1.11–12.63, p = 0.037), ≥ 2 episodes of recurrent anterior uveitis (RR 8.52, 95% CI 2.02–35.92, p < 0.001), angle-closure disease (ACD, RR 7.08, 95% CI 2.44–20.48, p < 0.001), iris bombé (RR 5.0, 95% CI 2.10–11.90, p < 0.001), and peripapillary atrophy (RR 3.56, 95% CI 1.43–8.85, p < 0.001). Exposure to > 24 months of oral (RR 9.33, 95% CI 2.21–39.28, p < 0.001) or > 12 months of topical corticosteroids (RR 3.88, 95% CI 1.31–11.46, p = 0.007) were associated with an increased likelihood for secondary glaucoma development. Conclusion Glaucoma is a frequent complication of VKH, often attributed to mixed pathogenic mechanisms. Chronic disease at presentation, recurrent inflammation, angle-closure mechanisms, iris bombé, and peripapillary atrophy represent clinically significant risk factors for developing secondary glaucoma. Prompt and aggressive steroid-spearing immunosuppressive therapy for adequate inflammation control may lower the risk of glaucoma in VKH.

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“…The optimal management of acute VKH with a combination of a corticosteroid and a nonsteroidal immunosuppressive agent is critical for avoiding disease progression to the chronic recurrent phase, which may occur in up to two-thirds of patients [20]. Impending disease progression can only be possible if prompt and adequate treatment is started within three weeks of symptoms onset [3].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Secondary Glaucoma in Patients with Vogt-Koyanagi-Harada Disease

Alvarez-Guzman

Hartleben-Matkin²,

Ruiz-Lozano

et al. 2021

Preprint

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Background: To identify the prevalence and risk factors for secondary glaucoma among Mexican-mestizo patients with Vogt-Koyanagi-Harada Disease (VKH). A retrospective cohort study was conducted to identify the risk factors for developing secondary glaucoma based on demographic, clinical, and epidemiological variables of VKH Mexican-mestizo patients. Risk estimates were calculated using a Cox proportional hazards regression model. Main text: One hundred eyes of 50 patients, 44 (88%) women and 6 men (12%) with a median age of 35.5 years (IQR 29 – 46), and a median follow-up time of 72 months (IQR 13.7 – 126.7) were included for analysis. The prevalence of glaucoma was 20%, with angle-closure glaucoma accounting for 70% of all cases. Significant clinical risk factors for glaucoma development were a chronic recurrent stage at presentation (RR 2.88 95% CI 1.11 – 12.63, p=0.037), more than two episodes of recurrent anterior uveitis (RR 8.52 95% CI 2.02 – 35.92, p<0.001), angle-closure disease (ACD, RR 7.08 95% CI 2.44 – 20.48, p<0.001), iris bombé (RR 5.0 95% CI 2.10 – 11.90, p<0.001), and peripapillary atrophy (RR 3.56 95% CI 1.43 – 8.85, p<0.001). Exposure to prednisone for more than 24 months (RR 9.33 95% CI 2.21 – 39.28, p<0.001) or topical corticosteroid drops for more than 12 months (RR 3.88 95% CI 1.31 – 11.46, p=0.007) were associated with an increased likelihood for secondary glaucoma development. Conclusions: Glaucoma is a frequent complication in patients with VKH, often attributed to mixed pathogenic mechanisms. Chronic disease at presentation, recurrent inflammation, angle-closure mechanisms, iris bombé, and peripapillary atrophy represent clinically significant risk factors for secondary glaucoma development. Prompt and aggressive steroid-spearing immunosuppressive therapy for reaching adequate control of inflammation may lower the risk of glaucoma in VKH patients.

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Vogt–Koyanagi–Harada disease: recurrence rates after initial-onset disease differ according to treatment modality and geographic area

Cited by 15 publications

References 61 publications

Clinical Characteristics and Efficacy of Adalimumab and Low-Dose Methotrexate Combination Therapy in Patients With Vogt–Koyanagi–Harada Disease

Clinical Characteristics and Efficacy of Adalimumab and Low-Dose Methotrexate Combination Therapy in Patients With Vogt–Koyanagi–Harada Disease

Risk factors for secondary Glaucoma in patients with Vogt-Koyanagi-Harada disease

Risk Factors for Secondary Glaucoma in Patients with Vogt-Koyanagi-Harada Disease

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