The following is a summary of ‘Outcomes in Patients With Vogt–Koyanagi–Harada Disease From the First-Line Antimetabolites for Steroid-Sparing Treatment Uveitis Trial,” published in the June 2024 issue of Ophthalmology by Acharya et al.

Researchers conducted a prospective study comparing methotrexate (MTX) and mycophenolate mofetil (MMF) to see which works better at controlling uveitis without needing many steroids in people with Vogt-Koyanagi-Harada (VKH) disease. 

They analyzed patients with VKH from the FAST Uveitis Trial, a randomized, observer-masked study. Patients with noninfectious uveitis underwent a standardized corticosteroid taper and were randomly assigned to either weekly oral MTX (25mg) or twice-daily oral MMF (1.5g). The treatment success (corticosteroid-sparing control) was measured at 6 months, along with changes in best spectacle-corrected visual acuity (BSCVA), retinal central subfield thickness (CST), and resolution of serous retinal detachment (SRD).

The results showed 216 patients, 93 had VKH, 46 were on MTX, and 39 were on MMF, contributing to the primary outcome. Treatment success rates were 80.4% for MTX and 64.1% for MMF (P=0.12). Improvement in BSCVA showed no significant difference (P=0.78). The MTX was better than MMF in reducing CST (P=0.003) and resolving SRD (P=0.02). Treatment success didn’t differ by disease stage (P=0.25), but patients with acute VKH had greater BSCVA improvement (P<0.001) and CST reduction (P=0.02) than patients with chronic VKH. 

Investigators concluded that both MTX and MMF were effective in VKH as steroid-sparing treatments. Visual acuity improved more in acute VKH compared to chronic VKH.

Source: ajo.com/article/S0002-9394(24)00248-4/abstract#%20