Earlier immunomodulatory treatment is associated with better visual outcomes in a subset of patients with Vogt-Koyanagi-Harada disease.

Abstract

PURPOSE:

To evaluate clinical outcomes of first-line immunomodulatory therapy (IMT) and prednisone alone or late IMT in Vogt-Koyanagi-Harada disease.

METHODS:

Retrospective cohort study of 152 patients with Vogt-Koyanagi-Harada disease evaluated in a referral uveitis clinic in Chile from 1985 to 2011. Medical records of these patients were reviewed. Demographic data, clinical evaluation, type of treatment, functional outcomes, glucocorticoid (GC) dose and complications were recorded. Multivariate logistic regression was used to identify prognostic factors of poor response to GC.

RESULTS:

There were no significant differences between first-line IMT group and prednisone alone/late IMT group in terms of visual acuity (VA) improvement, complications and GC sparing effect. There was a trend for a higher frequency of systemic adverse effects leading to discontinuation of treatment in patients receiving IMT than in those receiving prednisone (14.6% and 6.5%, respectively). The subgroup of patients with poor response to GC who showed functional improvement had a significantly earlier time to IMT initiation than the patients who had no improvement. We identified following prognostic factors of poor response to GC: VA ≤ 20/200, fundus depigmentation, chronic disease and tinnitus at diagnosis. Patients with a prognostic factor (excluding tinnitus) and VA improvement had an earlier IMT initiation than those who had worse functional outcome.

CONCLUSION:

There were no differences in outcomes between first-line IMT and prednisone alone/late IMT in the entire VKH group. However, in a subset of patients, there was a significant better functional outcome with earlier IMT initiation.

• Authors: Cristhian A Urzua, Victor Velasquez, Pablo Sabat, Osvaldo Berger, Sebastian Ramirez, Annelise Goecke, Darío H Vásquez, Hector Gatica, Julia Guerrero
• Journal: Acta ophthalmologica (Acta Ophthalmol) Vol. 93 Issue 6 Pg. e475-80 (Sep 2015) ISSN: 1755-3768 [Electronic] England
• PMID: 25565265 (Publication Type: Journal Article)
• Copyright: © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Chemical References

• Glucocorticoids
• Immunosuppressive Agents
• Prednisolone

Topics

• Adult
• Drug Therapy, Combination
• Female
• Glucocorticoids (adverse effects, therapeutic use)
• Humans
• Immunomodulation
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Male
• Middle Aged
• Prednisolone (adverse effects, therapeutic use)
• Retrospective Studies
• Uveomeningoencephalitic Syndrome (drug therapy, physiopathology)
• Visual Acuity (physiology)
• Young Adult