HIGH LONG-TERM DRUG-FREE REMISSION RATE FOR ACUTE VOGT–KOYANAGI–HARADA DISEASE WITH AN APPROPRIATE IMMUNOSUPPRESSIVE REGIMEN

Abstract

Purpose: To report the clinical profile and outcomes of acute Vogt–Koyanagi–Harada disease with a strict immunosuppression regimen and investigate the risk factors for a prolonged disease course. Methods: A total of 101 patients with acute Vogt–Koyanagi–Harada (202 eyes) with more than 24 months of follow-up were recruited from January 2011 to June 2020. They were divided into two groups according to the interval between the onset of Vogt–Koyanagi–Harada and treatment. Oral prednisone was gradually tapered off by a diminished dose according to a relatively strict protocol. Patient responses to the treatment regimen were classified as long-term drug-free remission or chronic recurrent. Results: Ninety-six patients (95.0%) achieved long-term drug-free remission without recurrence, while 5 (5.0%) had chronic recurrence. Most patients achieved good best-corrected visual acuity (90.6% ≧20/25). A generalized estimation equation model demonstrated that time of visit, ocular complications, and cigarette smoking were independent risk factors for a longer disease course, and smokers required a higher drug dose and longer treatment course than nonsmokers. Conclusion: An immunosuppressive regimen with an appropriate tapering speed can lead to long-term drug-free remission in patients with acute Vogt–Koyanagi–Harada. Cigarette smoking significantly affects ocular inflammation.