Incidence of and Predictive Factors for Remission among Patients with Early Vogt-Koyanagi-Harada (VKH) Disease Treated with Systemic Corticosteroids and Conventional Immunosuppression
Purpose
To describe the incidence of and predictive factors for remission among patients with early VKH treated with corticosteroids with or without conventional immunosuppression.
Methods
A retrospective charts review was performed on patients diagnosed with early VKH between 2011 and 2020. The main outcome measurement was the incidence of remission, defined as inactive disease off all medication for ≥ 3 months.
Results
Fifty-nine patients (118 eyes) with a follow-up period of ≥6 months were included. Among them, 37 (62.7%) received oral prednisolone combined with conventional immunosuppressive drugs, whereas 22 (37.3%) received oral prednisolone monotherapy throughout the treatment course. The mean visual acuity (VA) improved from 0.93 at baseline to 0.21 logMAR at 1 year. Over a median follow-up of 3.2 years (IQR, 1.4-5.5), remission was achieved in 28/59 patients [rate = 0.17/person-year (PY); 95% CI: 0.12, 0.24]. The median time to remission was 3.7 years. Corticosteroid-sparing success was achieved in 53/59 patients (rate = 0.85/PY; 95% CI: 0.76, 0.94). The median time to corticosteroid-sparing success was 0.9 years. Better presenting VA (adjusted hazard ratio [aHR] 1.8; 95% CI: 1.1-3.1), lower presenting anterior chamber (A/C) cell grading (aHR 1.8; 95% CI: 1.2-2.7), and receiving systemic corticosteroids within 14 days of disease onset (aHR 6.5; 95% CI: 2.4-17.7) increased the likelihood of remission.
Conclusion
Approximately half of patients with early VKH remitted within 4 years. Better presenting VA, lower presenting A/C cell grading, and early corticosteroid therapy were predictive of remission.
Conflict of interest
No
Authors 1
Last name
PHINITKITANAN
Initials of first name(s)
P
Department
Ophthalmology, Faculty of Medicine, Prince of Songkla University
City
Songkhla
Country
Thailand
Authors 2
Last name
SITTIVARAKUL
Initials of first name(s)
W
Department
Ophthalmology, Faculty of Medicine, Prince of Songkla University
City
Songkhla
Country
Thailand
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