Comparative analysis of different treatment schedules in the course of Vogt-Koyanagi-Harada disease (VKHD)

Abstract

Purpose : To compare clinical and electroretinogram (ERG) outcomes in VKHD patients treated with different treatment protocols.

Methods : Twenty three patients (21 female) with VKHD from acute onset were systematically followed during a minimum 24-mo follow-up as part of an ongoing study started on 2011. All patients were initially treated with 3-day 1g methylprednisolone pulsetherapy followed by 1mg/kg/d oral prednisone with slow tapering. Treatment were corticosteroid only (n=6, group 1), early immunosuppressive therapy (IMT), i.e. ideal IMT before M4 (n=5, group 2), ideal IMT between M4 and M7 (n=6, group 3) and ideal IMT > M7 (n=6, group 4). IMT consisted of azathioprine (2mg/kg/d) followed by mofetil mycophenolate (2g/d) in intolerant or refractory patients. Clinical and posterior segment imaging inflammation on Spectralis HRA+OCT, i.e. fluorescein (FA) and indocyanine green (ICGA) angiographies and enhanced depth optical coherence tomography (EDI-OCT) and full-field (ff) ERG on RETIportsystem were systematically carried out. Variation ≥ 30% of scotopic ffERG parameters represented the ff-ERG based worsening group. Descriptive statistics, Kruskal-Wallis, Likelihood ratio and Dunn’s multiple comparison tests were used to analyze data. This study was approved by the Institutional Ethics Committee and followed the Helsinki declaration.

Results : At disease onset, the four groups did not differ on clinical basis (Table). Nevertheless, group 3 had the worst visual acuity at M1 (p=0.593) during the 24-mo follow-up and the highest pleocytosis (p=0.983) suggesting a more severe disease group from the onset. All eyes from Group 3 had sunset glow fundus (p=0.044). Anterior chamber cells fluctuation was not observed in group 1 (p=0.052). Presence of other inflammatory signs did not differ between treatment groups. Nevertheless, dark dots (DD) scores were significantly lower in group 2 (p-0.022). During follow-up, 14 eyes (30.4%) were defined as ffERG worsening group and 32 eyes (69.6%) as ffERG stable group. FfERG worsening group had no correlation with inflammatory signs neither treatment schedule.

Conclusions : Different treatment schedules, including early IMT, in VKHD, during 24-mo follow-up, did not significantly differ on inflammation control neither on ffERG parameters. Nevertheless, earlier IMT did better control choroidal subclinical inflammation as observed by lowest dark dots score.

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