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Yang S, Tao T, Huang Z, Liu X, Li H, Xie L, Wen F, Chi W, Su W. Adalimumab in Vogt-Koyanagi-Harada Disease Refractory to Conventional Therapy. Front Med (Lausanne) 2022; 8:799427. [PMID: 35096888 PMCID: PMC8789678 DOI: 10.3389/fmed.2021.799427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background: No study explores the effectiveness of adalimumab in sight-threatening Vogt-Koyanagi-Harada (VKH) patients in China. Objective: To evaluate the short-term effectiveness and safety of adalimumab (ADA) in patients with sight-threatening Vogt-Koyanagi-Harada (VKH) disease refractory to conventional therapy. Methods: Medical records of VKH patients who had been treated with systemic glucocorticoids and immunosuppressants but whose condition was poorly controlled were collected and analyzed. Primary outcomes comprised of best-corrected visual acuity (BCVA), intraocular inflammation, relapses, and glucocorticoid-sparing effects. Other outcomes included central macular thickness (CMT), intraocular manifestations and adverse events (AEs). Results: Nine refractory VKH patients with a median age of 30 (16, 43) years old were enrolled in this study and received treatment for a median of 10 (7, 11) months. Mean BCVA improved from LogMar 0.63 ± 0.50 (20/72 or 0.36 ± 0.26 in Snellen chart) at baseline to LogMar 0.50 ± 0.37 (20/82 or 0.41 ± 0.28 in Snellen chart) at final visit (P = 0.090). The anterior chamber cell grade decreased from 2 (1.75, 3)+ at baseline to 0.5 (0, 1.25)+ cell at final visit (P < 0.001). The vitritis grade decreased from 1 (1, 1) + cell at baseline to 0 (0, 1)+ cell at final visit (P < 0.001). Patients suffered a median of 1 (0, 2) relapse during treatment. CMT remained stable from 238.50 ± 144.94 μm at baseline to 219.28 ± 77.20 μm at final visit (P = 0.553). The mean prednisone dosage decreased from 21.91 ± 18.39 mg/d to 2.73 ± 4.10 mg/d (P = 0.005). No severe AEs were found during treatment. Conclusions: The outcomes indicated that ADA was an effective and safe option for VKH patients refractory to conventional therapy by controlling inflammation, preserving visual function and reducing the daily glucocorticoid dose.
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Affiliation(s)
- Shizhao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tianyu Tao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhaohao Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiuxing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - He Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lihui Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Chi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Yalçındağ FN, Temel E, Özgür EG. Spectral domain optical coherence tomography findings of patients with pars planitis and risk factors affecting visual acuity. Int Ophthalmol 2021; 41:1753-1761. [PMID: 33559832 DOI: 10.1007/s10792-021-01734-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate spectral domain optical coherence tomography (SD-OCT) findings of 42 eyes with pars planitis and to identify risk factors affecting visual acuity. METHODS Medical records and SD-OCT findings were retrospectively reviewed. RESULTS Mean best-corrected visual acuity (BCVA) was 0.248 ± 0.3 on the logMAR scale at baseline. SD-OCT findings included epiretinal membrane (ERM) in 16 (38.1%) eyes, loss of normal foveal contour appearance in 8 (19.0%), ellipsoid zone (EZ) damage in 5 (11.9%), external limiting membrane (ELM) damage in 3 (7.1%), disruption of retinal pigment epithelium (RPE) in 2 (4.8%), and macular atrophy in 1 (2.4%). There was macular edema in 10 (23.8%) eyes [cystoid macular edema (CME) in 8 (19.0%), diffuse macular edema (DME) in 6 (14.3%), and serous retinal detachment in 2 (4.8%)]. The mean central macular thickness (CMT) was 272.1 ± 319.5 μm. Patients were followed up for a mean of 50.6 ± 36.7 months. Mean BCVA was 0.210 ± 0.3 at the final evaluation. SD-OCT findings included ERM in 28 (66.7%) eyes, EZ damage in 6 (14.3%), ELM damage in 3 (7.1%), disruption of RPE in 4 (9.5%), loss of normal foveal contour appearance in 12 (28.6%), and macular atrophy in 2 (4.8%). There was CME and/or DME in 6 (14.3%) eyes. The mean CMT was 238 ± 220.9 μm and was significantly lower than the baseline (p < 0.001). According to multivariate linear regression analysis, the presence of DME, and loss of normal foveal contour appearance at baseline were the independent factors associated with BCVA at the final examination (B = 0.726, p < 0.001; B = 0.766, p < 0.001, respectively). CONCLUSIONS DME and loss of normal foveal contour appearance were more likely to have adverse effects on visual acuity.
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Affiliation(s)
- F Nilüfer Yalçındağ
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emine Temel
- Department of Opthalmology, Kırşehir Ahi Evran Training and Research Hospital, Kırşehir, Turkey.
| | - Emrah Gökay Özgür
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
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McDonald J, Cassedy A, Altaye M, Andringa J, Cooper AM, Drews-Botsch C, Engelhard G, Hennard T, Holland GN, Jenkins K, Lambert SR, Lipscomb J, McCracken C, McCurdy DK, Mwase N, Prahalad S, Shantha J, Stahl E, Miraldi Utz V, Walker AA, Yeh S, Angeles-Han ST. Comprehensive assessment of quality of life, functioning and mental health in children with juvenile idiopathic arthritis and non-infectious uveitis. Arthritis Care Res (Hoboken) 2021; 74:1311-1320. [PMID: 33421338 PMCID: PMC8267048 DOI: 10.1002/acr.24551] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pediatric uveitis can lead to sight-threatening complications and impact quality of life (QOL) and functioning. We aim to examine health-related QOL (HRQOL), mental health, physical disability, vision-related functioning (VRF), and vision-related QOL (VRQOL) in children with juvenile idiopathic arthritis (JIA), JIA-associated uveitis (JIA-U), and other non-infectious uveitis. We hypothesize that there will be differences based on the presence of eye disease. METHODS A multicenter cross-sectional study was conducted at four sites. Patients with JIA, JIA-U, or non-infectious uveitis were enrolled. Patients and parents completed the PedsQL (HRQOL), RCADS (anxiety/depression), CHAQ (physical disability), and EYE-Q (VRF/VRQOL). Clinical characteristics and patient-reported outcome measures (PROMs) were compared by diagnosis. RESULTS Of 549 patients, 332 had JIA, 124 JIA-U, and 93 other uveitis. Children with JIA-U had worse EYE-Q scores compared to JIA only. In children with uveitis, those with anterior uveitis (JIA-U and uveitis only) had less ocular complications, better EYE-Q scores, and worse CHAQ and PedsQL physical summary scores compared to those with non-anterior disease. In children with anterior uveitis, those with JIA-U had worse PedsQL physical summary and CHAQ scores than anterior uveitis only. Further, EYE-Q scores were worse in children with bilateral uveitis and more visual impairment. There were no differences in RCADS scores among groups. CONCLUSION We provide a comprehensive outcome assessment of children with JIA, JIA-U, and other uveitis diagnoses. Differences in QOL and function were noted based on underlying disease. Our results support the addition of a vision-specific measure to better understand the impact of uveitis.
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Affiliation(s)
- Joseph McDonald
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Andringa
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Ashley M Cooper
- Division of Rheumatology, Children's Mercy Hospital, Kansas City, MO, United States.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Carolyn Drews-Botsch
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - George Engelhard
- Division of Educational Psychology, The University of Georgia, Athens, GA, United States
| | - Theresa Hennard
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Gary N Holland
- UCLA Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | | | - Scott R Lambert
- Department of Ophthalmology, Stanford University, Stanford, United States
| | - Jessi Lipscomb
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Deborah K McCurdy
- Department of Pediatrics and David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Najima Mwase
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Childrens Healthcare of Atlanta, Athens, GA, United States
| | - Jessica Shantha
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Erin Stahl
- Section of Pediatric Ophthalmology, Children's Mercy Hospital, Kansas City, MO, United States.,Department of Ophthalmology, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Virginia Miraldi Utz
- Division of Ophthalmology, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, United States
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sheila T Angeles-Han
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Section of Pediatric Ophthalmology, Children's Mercy Hospital, Kansas City, MO, United States
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Albaroudi N, Tijani M, Boutimzine N, Cherkaoui O. Clinical and therapeutic features of pediatric Vogt-Koyanagi-Harada disease. J Fr Ophtalmol 2020; 43:427-432. [PMID: 32115269 DOI: 10.1016/j.jfo.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze clinical, therapeutic and prognostic features of pediatric Vogt-Koyanagi-Harada (VKH) disease. MATERIAL AND METHODS This retrospective study included 16 eyes of 8 children diagnosed with VKH disease followed at a teaching hospital over a 10 year period. Diagnosis was based on the revised criteria of VKH disease. All data were analyzed using SPSS® software. RESULTS There were 62.5% girls and 37.5% boys. The mean age (years) was 14.6±4.4. The mean follow-up (months) was 38.7±28.7. The mean initial visual acuity (VA) (LogMAR) was 1.4 with 68.8% of eyes presenting with severe visual loss at admission. The median time (days) required for resorption of the serous retinal detachment was 10 [8.25-25]. Extraocular signs were present in 62.5% of cases. The mean time until initiation of treatment was 25.6 days. 62.5% of patients received corticosteroids alone, and 37.5% of patients received a combination of corticosteroids and immunosuppressive therapy. Final VA was 0.4 [0.1-2.3]. In our study, the time until consultation, low initial VA and recurrences were statistically associated with severe visual loss (P≤0.05). CONCLUSION Life expectancy in pediatric cases of VKH disease justifies the early initiation of immunosuppressive treatment or even biological therapy to achieve better steroid sparing and preserve visual function.
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Affiliation(s)
- N Albaroudi
- Service d'ophtalmologie A, hôpital des spécialités, centre hospitalier universitaire, université Mohammed V, Rabat, Morocco.
| | - M Tijani
- Service d'ophtalmologie A, hôpital des spécialités, centre hospitalier universitaire, université Mohammed V, Rabat, Morocco
| | - N Boutimzine
- Service d'ophtalmologie A, hôpital des spécialités, centre hospitalier universitaire, université Mohammed V, Rabat, Morocco
| | - O Cherkaoui
- Service d'ophtalmologie A, hôpital des spécialités, centre hospitalier universitaire, université Mohammed V, Rabat, Morocco
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