Outcomes of Vogt-Koyanagi-Harada Disease: A Subanalysis From a Randomized Clinical Trial of Antimetabolite Therapies.
OBJECTIVE
To report outcomes of Vogt-Koyanagi-Harada (VKH) disease from a clinical trial of antimetabolite therapies.


METHODS
Subanalysis from an observer-masked randomized clinical trial for noninfectious intermediate, posterior, and panuveitis.


METHODS
setting: Clinical practice at Aravind Eye Hospitals, India.


METHODS
Forty-three of 80 patients enrolled (54%) diagnosed with VKH.


METHODS
Patients were randomized to either 25 mg oral methotrexate weekly or 1 g mycophenolate mofetil twice daily, with a corticosteroid taper.


METHODS
Primary outcome was corticosteroid-sparing control of inflammation at 5 and 6 months. Secondary outcomes included visual acuity, central subfield thickness, and adverse events. Patients were categorized as acute (diagnosis ≤3 months prior to enrollment) or chronic (diagnosis >3 months prior to enrollment).


RESULTS
Twenty-seven patients were randomized to methotrexate and 16 to mycophenolate mofetil; 30 had acute VKH. The odds of achieving corticosteroid-sparing control of inflammation with methotrexate were 2.5 times (95% CI: 0.6, 9.8; P = .20) the odds with mycophenolate mofetil, a difference that was not statistically significant. The average improvement in visual acuity was 12.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. On average, visual acuity for patients with acute VKH improved by 14 more ETDRS letters than those with chronic VKH (P < .001), but there was no difference in corticosteroid-sparing control of inflammation (P = .99). All 26 eyes with a serous retinal detachment at baseline resolved, and 88% achieved corticosteroid-sparing control of inflammation.


CONCLUSIONS
The majority of patients treated with antimetabolites and corticosteroids were able to achieve corticosteroid-sparing control of inflammation by 6 months. Although patients with acute VKH gained more visual improvement than those with chronic VKH, this did not correspond with a higher rate of controlled inflammation.
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California.
Elizabeth
E
Shen
Aravind Eye Care System, Madurai, India.
Sivakumar R
SR
Rathinam
Aravind Eye Care System, Coimbatore, India.
Manohar
M
Babu
Aravind Eye Care System, Coimbatore, India.
Anuradha
A
Kanakath
Aravind Eye Care System, Madurai, India.
Radhika
R
Thundikandy
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California.
Salena M
SM
Lee
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California.
Erica N
EN
Browne
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
Travis C
TC
Porco
F.I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California. Electronic address: nisha.acharya@ucsf.edu.
Nisha R
NR
Acharya
D000328:Adult; D004334:Drug Administration Schedule; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D015864:Panuveitis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014607:Uveomeningoencephalitic Syndrome / Q000188:drug therapy*; D014792:Visual Acuity
D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D008727:Methotrexate