Multicenter, retrospective, observational study for the Treatment Pattern of systemic corticoSTERoids for relapse of non-infectious uveitis accompanying Vogt-Koyanagi-Harada disease or sarcoidosis.

Abstract

Non-infectious uveitis associated with Vogt-Koyanagi-Harada (VKH) disease or sarcoidosis is commonly treated with systemic corticosteroids (SCS). We assessed the use of SCS for non-infectious uveitis relapses in Japanese clinical practice. Multicenter, retrospective chart review (UMIN Clinical Trial Registry; UMIN000032390). One hundred fifty-seven patients (15- ≤ 75years; 103 VKH disease, 54 sarcoidosis) given SCS to treat a relapse of non-infectious intermediate, posterior, or panuveitis accompanying VKH disease or sarcoidosis were studied (August 2011-December 2018). SCS dose and duration, concomitant medications, subsequent relapses, and steroid-related adverse drug reactions (ADRs) were analyzed for 12months after target relapse treatment. Relationships between background factors and total SCS dose were analyzed (logistic regression). Mean (± SD) total SCS dose over 12months after target relapse treatment was 3874 ± 2775mg, and was higher in patients with immunosuppressants than in those without (4575mg vs 3496mg). Immunosuppressant use was the only factor significantly associated with higher total SCS dose (p = 0.0196). Mean duration of SCS treatment for relapse was 318.7 ± 89.3days. Only 29.3% of patients were steroid-free after 12months; the percentage was higher in patients without immunosuppressants (36.3% vs 16.4%). Subsequent relapse was experienced by 39.5% of patients, and 13.4% had a steroid-related ADR (mostly glaucoma or diabetes). In Japanese clinical practice, many patients with recurrent uveitis accompanying VKH disease or sarcoidosis received SCS for relapse for ≥ 300days, suggesting that reducing corticosteroids is challenging in patients with difficulty suppressing inflammation.