From the Guidelines
The treatment of Vogt-Koyanagi-Harada (VKH) disease should include mycophenolate mofetil as a first-line steroid-sparing therapy, in combination with high-dose oral corticosteroids, to control inflammation and maintain vision. The use of mycophenolate mofetil in VKH disease is supported by a grade C recommendation, as it has been shown to be effective in controlling inflammation and maintaining vision, with no evidence of superiority over methotrexate 1. Initial therapy should consist of high-dose systemic corticosteroids, typically starting with intravenous methylprednisolone 1g daily for 3 days, followed by oral prednisone 1-2 mg/kg/day.
Some key points to consider when treating VKH disease include:
- The importance of prompt and aggressive immunosuppression to prevent vision loss and recurrent inflammation
- The need for regular monitoring of intraocular pressure and development of cataracts during treatment
- The potential use of biological agents, such as adalimumab or infliximab, in refractory cases
- The role of local therapy with periocular or intravitreal corticosteroid injections in managing acute flares
The choice of immunosuppressive agent should be based on the individual patient's needs and response to treatment, with mycophenolate mofetil being a suitable option for many patients 1. It is essential to note that the evidence for other mycophenolate preparations is not robust, and mycophenolate mofetil is the preferred choice due to its moderate efficacy and low rates of discontinuation resulting from adverse events 1.
From the Research
Treatment Options for VKH
- The treatment of Vogt-Koyanagi-Harada (VKH) disease typically involves the use of corticosteroids, with or without immunosuppressive agents 2, 3, 4, 5, 6.
- High-dose corticosteroids are often used as the initial treatment, with the goal of reducing inflammation and preventing complications 2, 4.
- Immunomodulatory therapy, such as cyclosporine and mycophenolate mofetil, may be used as first-line therapy to reduce the development of complications and improve visual outcomes 2, 3.
- The use of immunosuppressive agents, such as MMF, has been shown to be effective in controlling the disease and improving visual acuity 3, 6.
- Anti-TNF agents are also being used as a treatment option for VKH, although more data is needed to determine their effectiveness as a first-line treatment 3.
Factors Affecting Treatment Outcomes
- The severity of anterior segment inflammation and the presence of exudative retinal detachment at presentation can affect treatment outcomes 2.
- The use of immunomodulatory therapy and the timing of treatment initiation can also impact treatment outcomes 2, 3.
- Visual acuity at the time of treatment initiation and the duration of treatment can also influence visual outcomes 3, 6.
Treatment Regimens
- A reduced dose of corticosteroids combined with immunosuppressive agents has been shown to be an effective treatment regimen for VKH disease 6.
- The use of corticosteroids with gradual tapering off, combined with immunosuppressive agents, may be necessary for some patients 4.
- The choice of immunosuppressive agent and the duration of treatment may vary depending on the individual patient's response to treatment and the severity of the disease 3, 5.