Two-phase corticosteroid therapy for acute Vogt-Koyanagi-Harada disease

Abstract

Purpose : To investigate the effectiveness of two-phase corticosteroid therapy for acute-phase Vogt-Koyanagi-Harada disease (VKHD).

Methods : We conducted a retrospective analysis of 22 cases with acute-phase VKHD who underwent two-phase corticosteroid therapy at Kobe University Hospital and were followed for over one year. Two-phase corticosteroid therapy comprised the 'inflammatory phase,' during which prednisolone (PSL) was administered at a dose of 20 mg/day or more until the disappearance of hypofluorescence dark dots on indocyanine green angiography, and the 'steroid withdrawal phase,' involving a gradual tapering and discontinuation of steroids, commencing at PSL 20 mg/day. The primary outcome measure was the rate of recurrence of ocular inflammation within one year after the cessation of PSL.

Results : The mean age was 52.1 ± 18.0 years, with 73% of the cases being female. The mean number of steroid pulse therapies was 0.9 ± 1.0, and half of the cases were treated solely with oral PSL. The average starting dose of PSL was 28.4 ± 4.2 mg/day. The mean durations for the inflammatory phase, steroid withdrawal phase, and total steroid administration period were 56.1 ± 26.8 days, 261.2 ± 97.9 days, and 318.3 ± 100.5 days, respectively. The average follow-up period after PSL discontinuation was 26.3 ± 12.1 months. We observed one case of ocular inflammation recurrence within one year after PSL cessation, resulting in a recurrence rate of 5%. This particular case experienced a relapse at a PSL dose of 1 mg/day and had received a COVID-19 vaccine two weeks prior.

Conclusions : Two-phase corticosteroid therapy, categorizing steroid treatment into the 'inflammatory phase' and the 'steroid withdrawal phase,' holds the potential to suppress the recurrence of inflammation during the treatment period in acute-phase VKHD.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.