Evaluation of the use of adalimumab in the treatment of VKH disease and sympathetic ophthalmia
Purpose
To evaluate outcomes in patients with either Vogt-Koyanagi-Harada (VKH) disease or sympathetic ophthalmia (SO) who received adalimumab (ADA) during their treatment course.
Methods
Clinical records of 5 patients were reviewed retrospectively. The mean age was 67.6 years at initiation of ADA, and the median follow-up on ADA was 13 months.
Results
Initial treatment consisted of high-dose systemic corticosteroids in 4 patients, followed by transition to cyclosporine (Cy) for steroid-sparing. In the remaining 1 patient with VKH disease, initial treatment consisted of bilateral sub-Tenon’s corticosteroid injections with immediate initiation of Cy. Transition to ADA therapy was initiated for Cy-induced renal dysfunction in all 5 patients, and posterior inflammatory recurrences in 1 patient. One patient developed injection site inflammation at 3 weeks on ADA, necessitating ADA discontinuation. Of the remaining patients, Cy was tapered in all 4 patients, and was completely discontinued in 3 patients by 6 months. No recurrences were observed in 3 patients, however 1 patient with continued to have posterior inflammatory recurrences despite ADA and Cy. Seven of 8 eyes had a best-corrected visual acuity of > 0.8 at initiation of ADA treatment, and this remained unchanged over follow-up.
Conclusion
The use of ADA was effective in allowing reduction or discontinuation of Cy in 4 of 5 patients with VHK disease or SO. We conclude that ADA is a useful addition to our immunomodulatory armamentarium for these diseases.
Conflict of interest
Yes
Details of conflicting interests
Annabelle A. Okada: consultant to AbbVie Japan, Astellas Pharma Japan, Bayer AG, Daiichi Sankyo; lecture fees from Alcon Pharm Japan, Mitsubishi Tanabe Pharma, Novartis Pharma Japan, Santen Pharmaceutical Corporation, Senju Pharmaceutical Corporation; grant support from Alcon Pharma Japan, Bayer Yakuhin, Mitsubishi Tanabe Pharma.
Hiroshi Keino: lecture fees from Santen Pharma Corporation, Alcon Pharma Japan,
Nikon Healthcare Japan, Senju Pharmaceutical Corporation;
grant and lecture fees from Mitsubishi Tanabe Pharma.
Author 1
Last name
NAKAYAMA
Initials of first name(s)
M
Department
Ophthalmology
City
Tokyo
Country
Japan
Author 2
Last name
ABE
Initials of first name(s)
S
Department
Ophthalmology
City
Tokyo
Country
Japan
Author 3
Last name
HAYASHI
Initials of first name(s)
I
Department
Ophthalmology
City
Tokyo
Country
Japan
Author 4
Last name
KEINO
Initials of first name(s)
H
Department
Ophthalmology
City
Tokyo
Country
Japan
Author 5
Last name
WATANABE
Initials of first name(s)
T
Department
Ophthalmology
City
Tokyo
Country
Japan
Author 6
Last name
ANDO
Initials of first name(s)
Y
Department
Ophthalmology
City
Tokyo
Country
Japan
Author 7
Last name
OKADA
Initials of first name(s)
A
Department
Ophthalmology
City
Tokyo
Country
Japan
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