July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
The possibility of discontinuation of biologics and bioholiday in the management of Vogt-Koyanagi-Harada disease
Author Affiliations & Notes
  • Noriyasu Hashida
    Dept of Ophthalmology, Osaka University Graduate School of Medicine, Suita, OSAKA, Japan
  • Kazunobu Asao
    Dept of Ophthalmology, Osaka University Graduate School of Medicine, Suita, OSAKA, Japan
  • Kei Nakai
    Dept of Ophthalmology, Osaka University Graduate School of Medicine, Suita, OSAKA, Japan
  • Kazuichi Maruyama
    Dept of Ophthalmology, Osaka University Graduate School of Medicine, Suita, OSAKA, Japan
  • Kohji Nishida
    Dept of Ophthalmology, Osaka University Graduate School of Medicine, Suita, OSAKA, Japan
  • Footnotes
    Commercial Relationships   Noriyasu Hashida, Otsuka Pharmaceytical Co., Ltd. (F); Kazunobu Asao, None; Kei Nakai, None; Kazuichi Maruyama, Menicon Co., Ltd (F); Kohji Nishida, HOYA Co., Ltd. (F), HOYA Co., Ltd. (P), Japan Alcon Co., Ltd. (F), Santen Pharmaceytical Co., Ltd. (F)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3505. doi:
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      Noriyasu Hashida, Kazunobu Asao, Kei Nakai, Kazuichi Maruyama, Kohji Nishida; The possibility of discontinuation of biologics and bioholiday in the management of Vogt-Koyanagi-Harada disease. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3505.

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

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Abstract

Purpose :
To report cases suggesting the possibility of discontinuation of biologics (biofree remission) and drug holiday (bioholiday) management in the treatment of Vogt-Koyanagi-Harada disease (VKH) by using adalimumab (ADA).

Methods : Three VKH patients refractory to conventional treatments who were introduced ADA for the management of inflammation were included in this study. Disease activities and the drugs to be used after the initiation of ADA were chronologically examined and also the possibility of biofree remission and bioholiday management were investigated.

Results : (Case 1) 46-year-old male, steroid-dependent type of VKH. This case was introduced ADA after the recurrence at systemic prednisolone (PSL) 20 mg/day during steroid tapering and maintained remission after ADA treatment. At the end of the ADA clinical trial (M11-327), discontinuation of biologics was achieved. Drug free and biofree remission were maintained for two years without recurrence. (Case 2) 45 year old female, steroid resistant type of VKH. This case was introduced ADA at the result of repeated recurrence after three times steroid pulse therapy. After completing the ADA clinical trial (M11-327), biofree remission were achieved however, it relapsed after 2 years. (Case 3) 56-year-old female, steroid resistant type of VKH. This case was introduced ADA at the result of repeated recurrence after four times steroid pulse therapy and incontrollable inflammation even high dose of oral PSL. Due to ADA in combination with oral PSL, PSL could be reduced to 5 mg/day. Low disease activity was achieved 6 months or longer, followed by monthly dosing interval of ADA, and finally one year after, discontinuation of biologics was achieved.

Conclusions : We have to take into consideration the facts such as the difficulty of achieving complete remission with ADA monotherapy, the difficulty of defining biofree remission and bioholiday, the possibility of natural remission process of the disease itself, however; it is necessary to consider treatment strategy with ADA therapy for achieving bioholiday remission and bioholiday management.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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