Outcomes of Vogt-Koyanagi-Harada Disease: A Subanalysis From a Randomized Clinical Trial of Antimetabolite Therapies

Purpose To report outcomes of Vogt-Koyanagi-Harada (VKH) disease from a clinical trial of antimetabolitetherapies. Design Subanalysis from an observer-masked randomized clinical trial for noninfectious intermediate, posterior, and panuveitis. Methods setting: Clinical practice at Aravind Eye Hospitals, India. patient population: Forty-three of 80 patients enrolled (54%) diagnosed with VKH. intervention: Patients were randomized to either 25 mg oral methotrexateweekly or 1 g mycophenolatemofetil twice daily, with a corticosteroid taper. main outcome measures: Primary outcome was corticosteroid-sparing control of inflammation at 5 and 6 months. Secondary outcomes included visual acuity, central subfield thickness, and adverse events. Patients were categorized as acute (diagnosis ≤3 months prior to enrollment) or chronic (diagnosis >3 months prior to enrollment). Results Twenty-seven patients were randomized to methotrexateand 16 to mycophenolatemofetil; 30 had acute VKH. The odds of achieving corticosteroid-sparing control of inflammation with methotrexatewere 2.5 times (95% CI: 0.6, 9.8; P = .20) the odds with mycophenolatemofetil, a difference that was not statistically significant. The average improvement in visual acuity was 12.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. On average, visual acuity for patients with acute VKH improved by 14 more ETDRS letters than those with chronic VKH ( P P = .99). All 26 eyes with a serous retinal detachment at baseline resolved, and 88% achieved corticosteroid-sparing control of inflammation. Conclusions The majority of patients treated with antimetabolitesand corticosteroids were able to achieve corticosteroid-sparing control of inflammation by 6 months. Although patients with acute VKH gained more visual improvement than those with chronic VKH, this did not correspond with a higher rate of controlled inflammation.