Cristhian A Urzua1,2,3, Victor Velasquez1,2, Pablo Sabat1,2, Osvaldo Berger4, Sebastian Ramirez2, Annelise Goecke3,5, Darío H Vásquez2, Hector Gatica3,5, Julia Guerrero3. 1. Uveitis Department, Salvador's Hospital, Santiago, Chile. 2. Ophthalmology Department, University of Chile, Santiago, Chile. 3. Physiology Program, Faculty of Medicine, University of Chile, Santiago, Chile. 4. Ophthalmology Department, Catholic University, Santiago, Chile. 5. Rheumatology Department, University of Chile Clinical Hospital, Santiago, Chile.
Abstract
PURPOSE: To evaluate clinical outcomes of first-line immunomodulatory therapy (IMT) and prednisone alone or late IMT in Vogt-Koyanagi-Harada disease. METHODS: Retrospective cohort study of 152 patients with Vogt-Koyanagi-Harada disease evaluated in a referral uveitis clinic in Chile from 1985 to 2011. Medical records of these patients were reviewed. Demographic data, clinical evaluation, type of treatment, functional outcomes, glucocorticoid (GC) dose and complications were recorded. Multivariate logistic regression was used to identify prognostic factors of poor response to GC. RESULTS: There were no significant differences between first-line IMT group and prednisone alone/late IMT group in terms of visual acuity (VA) improvement, complications and GC sparing effect. There was a trend for a higher frequency of systemic adverse effects leading to discontinuation of treatment in patients receiving IMT than in those receiving prednisone (14.6% and 6.5%, respectively). The subgroup of patients with poor response to GC who showed functional improvement had a significantly earlier time to IMT initiation than the patients who had no improvement. We identified following prognostic factors of poor response to GC: VA ≤ 20/200, fundus depigmentation, chronic disease and tinnitus at diagnosis. Patients with a prognostic factor (excluding tinnitus) and VA improvement had an earlier IMT initiation than those who had worse functional outcome. CONCLUSION: There were no differences in outcomes between first-line IMT and prednisone alone/late IMT in the entire VKH group. However, in a subset of patients, there was a significant better functional outcome with earlier IMT initiation.
PURPOSE: To evaluate clinical outcomes of first-line immunomodulatory therapy (IMT) and prednisone alone or late IMT in Vogt-Koyanagi-Harada disease. METHODS: Retrospective cohort study of 152 patients with Vogt-Koyanagi-Harada disease evaluated in a referral uveitis clinic in Chile from 1985 to 2011. Medical records of these patients were reviewed. Demographic data, clinical evaluation, type of treatment, functional outcomes, glucocorticoid (GC) dose and complications were recorded. Multivariate logistic regression was used to identify prognostic factors of poor response to GC. RESULTS: There were no significant differences between first-line IMT group and prednisone alone/late IMT group in terms of visual acuity (VA) improvement, complications and GC sparing effect. There was a trend for a higher frequency of systemic adverse effects leading to discontinuation of treatment in patients receiving IMT than in those receiving prednisone (14.6% and 6.5%, respectively). The subgroup of patients with poor response to GC who showed functional improvement had a significantly earlier time to IMT initiation than the patients who had no improvement. We identified following prognostic factors of poor response to GC: VA ≤ 20/200, fundus depigmentation, chronic disease and tinnitus at diagnosis. Patients with a prognostic factor (excluding tinnitus) and VA improvement had an earlier IMT initiation than those who had worse functional outcome. CONCLUSION: There were no differences in outcomes between first-line IMT and prednisone alone/late IMT in the entire VKH group. However, in a subset of patients, there was a significant better functional outcome with earlier IMT initiation.
Authors: Elizabeth Shen; Sivakumar R Rathinam; Manohar Babu; Anuradha Kanakath; Radhika Thundikandy; Salena M Lee; Erica N Browne; Travis C Porco; Nisha R Acharya Journal: Am J Ophthalmol Date: 2016-06-10 Impact factor: 5.258
Authors: Cristhian A Urzua; Carl Herbort; Rodrigo A Valenzuela; Ahmed M Abu El-Asrar; Lourdes Arellanes-Garcia; Ariel Schlaen; Joyce Yamamoto; Carlos Pavesio Journal: J Ophthalmic Inflamm Infect Date: 2020-09-14
Authors: K Diallo; S Revuz; G Clavel-Refregiers; T Sené; C Titah; M Gerfaud-Valentin; P Seve; R Jaussaud Journal: BMC Ophthalmol Date: 2020-10-07 Impact factor: 2.209