Efficacy and tolerance of early high‐dose corticosteroid therapy in Vogt‐Koyanagi‐Harada disease

Abstract

Abstract Purpose Early high dose corticosteroid therapy with "adequate" duration has become the mainstay therapy in Vogt‐Koyanagi‐Harada (VKH) disease. This work report the tolerance and side‐effects in a small series of VKH patients having received “maximal” Inflammation Suppressive Therapy (IST). Methods Medical records of VKH patients seen in the the COS uveitis clinic in Lausanne were analyzed. Standard care consisted in prolonged high IST including high dose oral prednisone (60‐200 mg/day), slowly tapered, with or without initial 3‐day megadose (500‐1000 mg of methylprednisolone) intravenous pulse therapy with adjunction of immunosuppressive therapy if necessary. Follow‐up time, total prednisone dose, duration of therapy, adjunctive immunosuppressive treatments, major side‐effects, clinical outcomes were recorded. Results Nine patients were included. Initial oral daily corticosteroid dose was above 60 mg of prednisone in all patients. Immunosuppressive therapy was used in 6 patients either to reinforce IST or to obtain a corticosteroid‐sparing effect. Major side effects were recorded in one patient who developed a bilateral aseptic hip necrosis needing bilateral hip replacement. Clinical outcomes were favorable in 8/9 patients with no sunset‐glow fundus at the one year follow‐up visit and with 7/9 patients beeing treatment free after a slow, mostly indocyanine green angiographically controlled tapering over more than 2 years. Conclusion High dose IST was relatively well tolerated and associated with favorable clinical outcome. Side‐effects of maximal IST are not to be minimized, but seem however acceptable in view of the favorable outcome induced. Treatment duration was found to be much longer than usually recommended in textbooks.