Purchase this article with an account.
Enzo A. Castiglione, Eugenia I. Abusleme, Claudio Perez, Jaime Tapia, Raul Escalona Parga; Early Introduction of Immunosuppressives in Vogt-Koyanagi-Harada Disease. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5484.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the early introduction of azathioprine (AZA) in the treatment of Vogt-Koyanagi-Harada Disease (VKH) and methotrexate (MTX) or cyclosporine (CsA) as supporting therapy.
Descriptive study of all the patients with a diagnosis of VKH in a tertiary eye clinic from November 2009 through November 2011 who began AZA within the first 2 months following diagnosis. Visual acuity (VA), adverse effects of treatment, doses of medications used, time to achieve remission after relapses, and follow-up period are analyzed.
We present data from 14 eyes of 7 patients. All patients were women with a mean age of 37 years (21 to 61 years). All patients started treatment with high-dose prednisone (PDN) at the time of diagnosis. On average, the time from the beginning of symptoms to diagnosis was 18 days. AZA was started a mean of 16.4 days after. The average initial dose for PDN and AZA were 55 and 50 mg/day, respectively. Maximum dose was 56 mg/day for PDN and 93 mg/day for AZA. Five of the seven patients had to discontinue AZA because of gastrointestinal adverse effects or hepatic intolerance after an average of 131 days of use. All patients gained VA. Expressed in the LogMAR scale, visual acuity was 0.69 at diagnosis, 0.19 at month 1, 0.08 at month 3, 0.07 at month 6 and 0.07 after 9 months. The improvement in VA between month 1 and month 3 was statistically significant (p=0.02). The improvement in VA after month 3 was not statistically significant. Patients achieved remission at an average of 36.6 days. Mild recurrent anterior chamber cells appeared in all patients after a mean of 89 days, while receiving PDN 22 mg/day and AZA 79 mg/day. As adjunct therapy, 3 patients used CsA, and 4 used MTX, being added to the treatment after a mean of 179 and 147 days, respectively. PDN doses decreased significantly after 9 months of control compared to control at 3 and 6 months (p=0.027 and p= 0.014 respectively).
Every eye achieved normal vision and complete control of inflammation after a 9-month follow up when VKH is treated with early introduction of AZA. Total dose of PDN was greatly reduced compared to historical records. VA kept improving significantly after month 1, unlike what is described in the literature. Early introduction of AZA was well tolerated only in 28.6% of the patients, which is lower than the 70-85% reported in other studies, mainly because of gastrointestinal side effects. All patients benefited from introduction of a second immunosuppressive drug (either MTX or CsA).The dosing regimen for PDN and AZA for the treatment of VKH still needs to be perfected, but the early use of AZA seems to be promising.
This PDF is available to Subscribers Only