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Earlier immunomodulatory treatment is associated with better visual outcomes in a subset of patients with V ogt‐ K oyanagi‐ H arada disease
Author(s) -
Urzua Cristhian A.,
Velasquez Victor,
Sabat Pablo,
Berger Osvaldo,
Ramirez Sebastian,
Goecke Annelise,
Vásquez Darío H.,
Gatica Hector,
Guerrero Julia
Publication year - 2015
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.12648
Subject(s) - medicine , prednisone , discontinuation , logistic regression , disease , medical record
Purpose To evaluate clinical outcomes of first‐line immunomodulatory therapy ( IMT ) and prednisone alone or late IMT in V ogt‐ K oyanagi‐ H arada disease. Methods Retrospective cohort study of 152 patients with V ogt‐ K oyanagi‐ H arada disease evaluated in a referral uveitis clinic in C hile 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.