Outcomes of Corticosteroids Combined with 15 Mg/Week Methotrexate as Initial Treatment for Acute Vogt-Koyanagi-Harada Disease.

Purpose: To evaluate the efficacy and safety of initial treatment combining corticosteroids and 15 mg/week methotrexate (MTX) for acute Vogt-Koyanagi-Harada disease (VKH).

Methods: A retrospective, longitudinal observational case series was conducted. Newly onset VKH patients received corticosteroids combining 15 mg/week MTX, and follow-up period ≥ 6 months were consecutively enrolled. Main outcome measures were the corticosteroid-sparing effect, improvements of visual function, changes of ophthalmic characteristics and recurrences.

Results: In this case series, 39 acute VKH patients (78 eyes) received corticosteroids combining oral MTX as first-line therapy. All the participants achieved corticosteroid-sparing effect and thereafter withdrew corticosteroids. At the last follow-up, 87.2% patients had managed to discontinue MTX. The median period of corticosteroids treatment was 9.2 (8.0-13.3) months, and the mean interval of MTX using was 18.0 ± 6.1 months. Eventually, 83.3% of eyes achieved visual acuity of 0.0 logMAR or better. All the eyes had retinal reattachment and the choroidal thickness significantly decreased. Sun-set glow fundus was identified in 18 eyes (23.1%). The microvascular perfusion was still defect despite the well-controlled inflammation. Recurrence occurred in five patients, with only one progressing to a chronic recurrent stage. No severe adverse event was observed.

Conclusion: Initial treatments with corticosteroids tapered over approximately 9 months and oral methotrexate (15 mg/week) for 18 months in acute VKH patients led to favorable visual outcomes, fairly low recurrence and good safety profile. These findings support the consideration of this combined treatment for acute VKH but should be tempered by recognizing the retrospective and non-control design.