title: Earlier immunomodulatory treatment is associated with better visual outcomes in a subset of patients with Vogt-Koyanagi-Harada disease.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.affiliation: Uveitis Department, Salvador's Hospital, Santiago, Chile.|Ophthalmology Department, University of Chile, Santiago, Chile.|Physiology Program, Faculty of Medicine, University of Chile, Santiago, Chile.
authors.forename: Cristhian A
authors.initials: CA
authors.lastname: Urzua
authors.affiliation: Uveitis Department, Salvador's Hospital, Santiago, Chile.|Ophthalmology Department, University of Chile, Santiago, Chile.
authors.forename: Victor
authors.initials: V
authors.lastname: Velasquez
authors.affiliation: Uveitis Department, Salvador's Hospital, Santiago, Chile.|Ophthalmology Department, University of Chile, Santiago, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Sabat
authors.affiliation: Ophthalmology Department, Catholic University, Santiago, Chile.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Berger
authors.affiliation: Ophthalmology Department, University of Chile, Santiago, Chile.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ramirez
authors.affiliation: Physiology Program, Faculty of Medicine, University of Chile, Santiago, Chile.|Rheumatology Department, University of Chile Clinical Hospital, Santiago, Chile.
authors.forename: Annelise
authors.initials: A
authors.lastname: Goecke
authors.affiliation: Ophthalmology Department, University of Chile, Santiago, Chile.
authors.forename: Darío H
authors.initials: DH
authors.lastname: Vásquez
authors.affiliation: Physiology Program, Faculty of Medicine, University of Chile, Santiago, Chile.|Rheumatology Department, University of Chile Clinical Hospital, Santiago, Chile.
authors.forename: Hector
authors.initials: H
authors.lastname: Gatica
authors.affiliation: Physiology Program, Faculty of Medicine, University of Chile, Santiago, Chile.
authors.forename: Julia
authors.initials: J
authors.lastname: Guerrero
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D056747:Immunomodulation; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D014607:Uveomeningoencephalitic Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone
keywords: Vogt-Koyanagi-Harada disease; complications; first-line treatment; functional outcomes; glucocorticoids; immunomodulatory treatment; prognostic factors