September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Outcomes of Vogt-Koyanagi-Harada disease from a randomized clinical trial of antimetabolite therapies
Author Affiliations & Notes
  • Elizabeth Shen
    F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States
  • Sivakumar R Rathinam
    Aravind Eye Care System, Madurai, India, Madurai, India
  • Manohar Babu
    Aravind Eye Care System, Coimbatore, India, Coimbatore, India
  • Anuradha Kanakath
    Aravind Eye Care System, Coimbatore, India, Coimbatore, India
  • Radhika Thundikandy
    Aravind Eye Care System, Madurai, India, Madurai, India
  • Salena Lee
    F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States
  • Erica Browne
    F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States
  • Travis Porco
    F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States
    Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States
  • Nisha Acharya
    F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States
    Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Elizabeth Shen, None; Sivakumar Rathinam, None; Manohar Babu, None; Anuradha Kanakath, None; Radhika Thundikandy, None; Salena Lee, None; Erica Browne, None; Travis Porco, None; Nisha Acharya, None
  • Footnotes
    Support  NEI U10 EY021125-01
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1899. doi:
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      Elizabeth Shen, Sivakumar R Rathinam, Manohar Babu, Anuradha Kanakath, Radhika Thundikandy, Salena Lee, Erica Browne, Travis Porco, Nisha Acharya; Outcomes of Vogt-Koyanagi-Harada disease from a randomized clinical trial of antimetabolite therapies. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1899.

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

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Abstract

Purpose : Outcomes of Vogt-Koyanagi-Harada (VKH) disease have primarily been reported from retrospective studies with varied treatment regimens. Prospective studies are needed to assess the efficacy of specific immunosuppressive agents for controlling inflammation. We present outcomes of VKH from a subanalysis of a clinical trial of antimetabolite therapies for non-infectious intermediate, posterior, and pan- uveitis.

Methods : Eighty patients from Aravind Eye Hospitals, South India, were randomized to 25mg methotrexate weekly or 1g mycophenolate mofetil twice daily, with a corticosteroid taper. Clinical eye exams, visual acuity measurements, and optical coherence tomography scans were conducted monthly for 6 months. The primary outcome was corticosteroid-sparing (≤10 mg oral prednisone daily) control of inflammation. Secondary outcomes included visual acuity, central subfield thickness, and adverse events. Mixed effects regression models were used to account for within-person correlation between eyes.

Results : Forty-three patients (54%) carried a diagnosis of VKH and 38 completed follow-up. Seventeen of 23 patients (74%) on methotrexate achieved control of inflammation in both eyes compared to 8 of 15 patients (53%) on mycophenolate mofetil (p=0.30). The median (IQR) visual acuity at enrollment was 0.29 (0.02, 0.54) logMAR, or 20/40 (20/20, 20/70), Snellen equivalent. The median improvement in visual acuity was 9.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Eighty-five percent of patients with acute VKH and 50% of patients with chronic VKH achieved 20/20 vision. Patients with acute VKH gained 14.1 ETDRS letters more than those with chronic VKH (p=0.002), but there was no difference in corticosteroid-sparing control of inflammation (p=0.99). Twenty-six eyes with complete follow-up had a serous retinal detachment (SRD) at baseline and had acute disease. All SRDs resolved, and 88% of these eyes also 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 with improved visual acuity. Although patients with acute VKH had greater visual improvement than those with chronic disease, this did not correspond to a higher rate of control of inflammation.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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