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High rate of clinical recurrence in patients with Vogt–Koyanagi–Harada disease treated with early high-dose corticosteroids

  • Inflammatory Disorders
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Abstract

Purpose

To analyse the rate of clinical recurrences in Brazilian patients with Vogt–Koyanagi–Harada (VKH) disease after early high-dose corticosteroid treatment.

Methods

Retrospective study including patients treated with early high-dose corticosteroids (prednisone, 1–1.5 mg/kg/day, or 3-day 1 g methylprednisolone pulsetherapy) within 1 month from disease onset followed by slow taper (at least 6 months). Patients with a minimum 12-month follow-up were subdivided based on the presence of disease recurrence or persistence after 6 months from initial presentation into: acute–resolved (AR, no recurrences), chronic–recurrent (CR), and chronic–recurrent with subretinal fibrosis (SRF). Recurrences were defined as the presence of clinical and/or fluorescein angiography findings.

Results

Twenty-nine patients (58 eyes) with a median follow-up of 65 months were included. Six (21 %), 11 (38 %) and 12 (41 %) patients were allocated to AR, CR, and SRF groups respectively. Though having received treatment within 1 month of onset, median time to initial treatment differed among groups (11, 15, and 25 days, in AR, CR, and SRF groups respectively). Intensity of immunosuppression, cataract development, and longer time to achieve logMAR visual acuity ≤0.8 differed significantly among the groups, being more severe in SRF group. HLA-DRB1*0405 allele followed the same trend, though not reaching significance (0.5 in AR group, 0.6 in CR, and 0.8 in SRF).

Conclusion

VKH disease in Brazilian patients evolved to chronic–recurrent disease in 79 % of cases; 38 % developed subretinal fibrosis, in spite of similar initial treatment regimens. Time to initiate treatment influenced outcomes.

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Acknowledgments

The authors thank Dr Rogério Ruscitto do Prado, Statistics Division, Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil, for his assistance with statistical analysis.

Funding

This work was supported in part by Fundação de Amparo à Pesquisa do Estado de São Paulo grant number #11/50936-7/scholarship #07/57154-9.

Conflict of interest statement

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript

Financial disclosure

The authors have no financial interest in the products mentioned in the manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Faculdade de Medicina, Universidade São Paulo, Rua Diana 863 apto 91J, São Paulo, SP, 05.019-000, Brazil

    Viviane M. Sakata, Carlos E. Hirata & Joyce H. Yamamoto

  2. Programa de pós-graduação em ambiente e saúde (PPGAS), Universidade do Planalto Catarinense, Lages, SC, Brazil

    Felipe T. da Silva

  3. Laboratory of Immunology, Heart Institute (InCor), Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brazil

    Maria Lucia C. Marin, Helcio Rodrigues & Jorge Kalil

  4. Division of Macula: Imaging & Treatment, Centro Brasileiro de Ciências Visuais, Belo Horizonte, MG, Brazil

    Rogerio A. Costa

  5. Department of Ophthalmology, Faculdade de Medicina de Ribeirão Preto, Universidade São Paulo, Ribeirão Preto, SP, Brazil

    Rogerio A. Costa

Authors
  1. Viviane M. Sakata
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  2. Felipe T. da Silva
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  3. Carlos E. Hirata
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  4. Maria Lucia C. Marin
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  5. Helcio Rodrigues
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  6. Jorge Kalil
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  7. Rogerio A. Costa
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  8. Joyce H. Yamamoto
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Corresponding author

Correspondence to Joyce H. Yamamoto.

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Cite this article

Sakata, V.M., da Silva, F.T., Hirata, C.E. et al. High rate of clinical recurrence in patients with Vogt–Koyanagi–Harada disease treated with early high-dose corticosteroids. Graefes Arch Clin Exp Ophthalmol 253, 785–790 (2015). https://doi.org/10.1007/s00417-014-2904-z

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  • DOI: https://doi.org/10.1007/s00417-014-2904-z

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