April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Adalimumab treatment in patients with Vogt-Koyanagi-Harada Syndrome
Author Affiliations & Notes
  • Cristobal A Couto
    Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
  • Maria de las Mercedes Frick
    Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
  • Erika Miolet Hurtado Jallaza
    Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
  • Matilde Lopez
    Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
  • Bernardo Ariel Schlaen
    Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
  • Footnotes
    Commercial Relationships Cristobal Couto, None; Maria de las Mercedes Frick, None; Erika Hurtado Jallaza, None; Matilde Lopez, None; Bernardo Schlaen, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 5798. doi:
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      Cristobal A Couto, Maria de las Mercedes Frick, Erika Miolet Hurtado Jallaza, Matilde Lopez, Bernardo Ariel Schlaen, ; Adalimumab treatment in patients with Vogt-Koyanagi-Harada Syndrome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5798.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To evaluate the clinical outcome and safety of treatment with Adalimumab in patients with Vogt-Koyanagi-Harada (VKH) disease with refractory uveitis.

Methods: Patients with VKH disease treated with Adalimumab for at least 6 months, in whom conventional therapy had failed were identified from April 2006 to April 2013. Patients in chronic stage treated with corticosteroids and immunosuppressives with active anterior and / or posterior inflammation were included. Adalimumab was administered on a compassionate off-label use basis at the dose of 40 mg subcutaneously every other week . The main outcome measures were BCVA, anterior segment inflammation (SUN) , efficacy of treatment in anterior and posterior inflammation, steroid sparing effect and reduction in concomitant immunosuppressive therapy.

Results: Fourteen patients , 4 male and 10 female , with a mean age of 23.07 ± 8.51 years ( r= 11-39 ) with a mean follow-up of 42.35 ± 37.55 months (r=8-132)and a mean duration of adalimumab treatment (AT) of 14.57 ± 11.54 months ( r=6-45) were included in this study. Regarding the systemic corticosteroid, the treatment with AT at 6 months was statistically significantly lower than the dose at baseline (Wilcoxon signed rank test, P= 0.0037). Furthermore, the dose at 12 months was statistically significantly lower than the dose at 6 months of AT( Wilcoxon signed rank test , P= 0.0157). Out of 14 patients,11 (78.57%) had IMT at baseline whereas 5 out of 14 (35.71%) had IMT at 6 months of AT (Mc Nemar's Chi square test = 4.50 ; P= 0.0339) , showing a trend toward statistical significance (p= 0.07). The comparison between anterior inflammation in OD previous to AT and the one observed at 6 months revealed a statistically significant difference with the binomial test for one sided (P=0.0001) and for two sided (P=0.0002) . The comparison between the anterior inflammation in OS previous to AT and the one observed at 6 months revealed a statistically significant difference with the binomial test for one sided(P=0.0002) and for two sided (P=0.0005). Four patients had recurrences within the first three months after the withdrawal of medication.

Conclusions: Our study showed the significant response to Adalimumab in 14 patients with diagnosis of VKH disease who were refractory to standard IMT. This anti-TNF agent seemed to be an effective and well-tolerated treatment for these patients.

Keywords: 557 inflammation • 746 uveitis-clinical/animal model • 432 autoimmune disease  
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