Purpose: To report outcomes of Vogt-Koyanagi-Harada (VKH) disease from a clinical trial of antimetabolite therapies.
Design: Subanalysis from an observer-masked randomized clinical trial for noninfectious intermediate, posterior, and panuveitis.
Methods: setting: Clinical practice at Aravind Eye Hospitals, India.
Patient Population: Forty-three of 80 patients enrolled (54%) diagnosed with VKH.
Intervention: Patients were randomized to either 25 mg oral methotrexate weekly or 1 g mycophenolate mofetil twice daily, with a corticosteroid taper.
Main Outcome Measures: 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.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969141 | PMC |
| http://dx.doi.org/10.1016/j.ajo.2016.06.004 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Outcomes of Corticosteroids Combined with 15 Mg/Week Methotrexate as Initial Treatment for Acute Vogt-Koyanagi-Harada Disease.
Ocul Immunol Inflamm
February 2025
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
Purpose: To evaluate the efficacy and safety of initial treatment combining corticosteroids and 15 mg/week methotrexate (MTX) for acute Vogt-Koyanagi-Harada disease (VKH).
Methods: A retrospective, longitudinal observational case series was conducted. Newly onset VKH patients received corticosteroids combining 15 mg/week MTX, and follow-up period ≥ 6 months were consecutively enrolled.
Clinical Outcomes in Peripheral Ulcerative Keratitis.
Am J Ophthalmol
January 2025
From the Wilmer Eye Institute, the Department of Ophthalmology, the Johns Hopkins University School of Medicine (K.M., P.L., M.K.B., J.T.W., B.B.B., D.A.J., J.E.T), Baltimore, Maryland, USA; the Department of Epidemiology, the Johns Hopkins Bloomberg School of Public Health (D.A.J, J.E.T), Baltimore, Maryland, USA. Electronic address:
Purpose: To evaluate clinical and treatment outcomes in patients with peripheral ulcerative keratitis (PUK).
Design: Retrospective, case series SUBJECTS: Patients diagnosed with PUK at the Wilmer Eye Institute between January 2003 and October 2022.
Methods: Data collected included demographics, presence of systemic disease, disease laterality, duration of disease, PUK activity, presence of corneal perforation, and treatments.
Real-world safety and effectiveness of mepolizumab for patients with eosinophilic granulomatosis with polyangiitis in Japan: long-term observation of the MARS study.
Mod Rheumatol
November 2024
Global Medical Affairs, GSK, London, UK.
Article Synopsis
- The MARS study aimed to collect long-term safety and effectiveness data for mepolizumab treatment in patients with eosinophilic granulomatosis with polyangiitis in Japan.
- In the study, conducted over 192 weeks, about 58% of patients experienced adverse events, but none were linked directly to mepolizumab. There were notable improvements in patient symptoms and a decrease in the need for oral glucocorticoids.
- The findings support that mepolizumab is well tolerated and effective for managing this condition, demonstrating an increase in symptom-free patients and decreased steroid dependency.
Biological and Therapeutic Role of Interleukin-6 in Non-Infectious Uveitis: A Narrative Review.
Ocul Immunol Inflamm
October 2024
Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
Article Synopsis
- - IL-6 inhibitors are emerging as effective treatments for non-infectious uveitis (NIU) that doesn't respond well to standard therapies, addressing key issues like inflammation and vision loss.
- - Review studies highlight that these biologic agents have succeeded in reducing inflammation in 34% to 88% of patients and decreasing dependency on corticosteroids by about 55%.
- - Although results are promising, showing improvements in visual acuity and macular edema, more research is necessary to confirm the long-term safety and effectiveness of IL-6 inhibitors in uveitis management.
Role of intravenous immunoglobulins in systemic sclerosis (SSc): A systematic literature review.
Semin Arthritis Rheum
October 2024
Department of Medicine, The University of Melbourne, Australia; Department of Rheumatology, St. Vincent's Hospital, Melbourne, Australia.
Background: Systemic sclerosis (SSc) is a heterogenous, multi-system autoimmune disease that causes progressive fibrosis of the skin and internal organs, resulting in high morbidity and mortality. Intravenous Immunoglobulin (IVIG) is a therapeutic option for SSc; however, reports of its efficacy have been variable, and its use across multiple organ manifestations of SSc has not been comprehensively reviewed.
Aim: The aim of this study was to systematically assess the existing literature on the role of IVIG use across a range of SSc manifestations.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!