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Steroid monotherapy versus steroid-cyclosporine combination therapy for the first onset of Vogt-Koyanagi-Harada disease Takemichi Kasama 1 , Riki Kitamura 1 , Shinpei Sugaoka 1 , Toshihiko Murata 1 , Koji Kanda 1 , Kei Takayama 1 , Tomohito Sato 1 , Kozo Harimoto 1 , Masaru Takeuchi 1 1Department of Ophthalmology, National Deffense Medical College pp.1406-1411
Published Date 2024/11/15
DOI https://doi.org/10.11477/mf.1410215394
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Abstract Purpose:Cyclosporine is a calcineurin inhibitor that selectively inhibits intracellular signaling in T cells. Since melanocyte antigen-specific T cells are assumed to be the main pathological factor in Harada disease, cyclosporine is expected to suppress the activation of these T cells. Although it has been reported that early concomitant use of immunosuppressive drugs is effective in improving prognosis and visual acuity, we conducted this study because 1)the efficacy of early treatment and 2)relapse during remission have not been sufficiently investigated when cyclosporine is used immediately after steroid pulse therapy.

Subjects and methods:Twenty-five patients diagnosed with untreated Harada's disease who had visited our ophthalmology clinic since October 2014 were divided into the steroid only group(8 males, 3 females, mean age 46.7±11.1 years)and the cyclosporine combination group(5 males, 9 females, mean age 46.8±11.9 years). The treatment efficacy over 2 years was compared.

Results:The logMAR visual acuity improvement of the combination group was 0.24 greater than that of the monotherapy group after one month of treatment. The magnitude of change in the subcentral choroid was generally in the range of 50 to 200 μm compared to that before the start of treatment, and there were no significant differences during the observation period. There was no difference in the recurrence rate, but only males in the monotherapy group and only females in the combined therapy group had recurrence. Subfoveal choroidal thickening, at the time of recurrence, occurred in the monotherapy group, but not in the combined therapy group.

Conclusions:There are sex-related differences in the efficacy of cyclosporine, and the characteristics of the findings at recurrence between the two groups differed.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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