Comparative study of efficacy and safety of pulse versus half-pulse steroid therapy for Vogt-Koyanagi-Harada Disease.

IF 1.9 3区医学 Q2 OPHTHALMOLOGY

Japanese Journal of Ophthalmology Pub Date : 2025-09-01 Epub Date: 2025-05-26 DOI:10.1007/s10384-025-01213-3

Kinya Tsubota, Hiroshi Goto, Masaki Asakage, Yuto Kinoshita, Ryota Nonaka, Kei Wakatsuki, Risa Sugawara, Ryosuke Fukai, Yoshihiko Usui

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Abstract

Purpose: High-dose steroid therapy is commonly used for Vogt-Koyanagi-Harada (VKH) disease in Japan, but the optimal initial dose remains uncertain. This study investigated the efficacy and safety of conventional steroid pulse therapy (pulse group) and half-dose steroid pulse therapy (half-pulse group) for the initial treatment of VKH disease.

Study design: This was a single-center, retrospective observational study based on a review of medical records.

Subjects and methods: Seventy-two patients with initial-onset VKH disease treated at Tokyo Medical University Hospital were analyzed. The pulse group (44 patients) received 1000 mg/day of intravenous methylprednisolone (MPSL), while the half-pulse group (28 patients) received 500 mg/day of MPSL. In both groups, steroids were tapered according to ocular findings, and the minimum follow-up period was eight months.

Results: Recurrence rate during follow-up period (pulse group: 41%, half-pulse group: 34%, p = 0.48), mean number of recurrences (pulse group: 1.9 ± 1.2, half-pulse group: 1.5 ± 0.9, p = 0.42), and type of recurrence (anterior uveitis: pulse group: 11%, half-pulse group: 17%, p = 0.33; posterior inflammation: pulse group: 34%, half-pulse group: 22%, p = 0.14) were not significantly different between the two groups. The proportion of patients requiring cataract surgery during the follow-up period tended to be higher in the pulse group (pulse group: 10%, half-pulse group: 3%, p = 0.12), although not significantly different. The incidence of sunset glow fundus was not significantly different between the two groups (pulse group: 23%, half-pulse group: 10%, p = 0.22).

Conclusions: No significant difference in clinical efficacy for VKH disease was observed between conventional steroid pulse therapy and half-pulse therapy, and by reducing the total steroid dose, half-pulse therapy potentially lowers the risk of adverse effects related corticosteroid.

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脉冲与半脉冲类固醇治疗Vogt-Koyanagi-Harada病的疗效和安全性比较研究。

目的：在日本，大剂量类固醇治疗常用于Vogt-Koyanagi-Harada （VKH）病，但最佳初始剂量仍不确定。本研究探讨常规类固醇脉冲治疗（脉冲组）和半剂量类固醇脉冲治疗（半脉冲组）初始治疗VKH疾病的疗效和安全性。研究设计：这是一项基于医疗记录综述的单中心、回顾性观察性研究。对象和方法：对东京医科大学医院72例初发VKH患者进行分析。脉冲组（44例）静脉注射甲基强的松龙（MPSL） 1000 mg/天，半脉冲组（28例）静脉注射MPSL 500 mg/天。两组患者均根据眼部情况逐渐减少类固醇治疗，最小随访时间为8个月。结果：随访期间复发率（脉冲组41%，半脉冲组34%，p = 0.48），平均复发次数（脉冲组1.9±1.2次，半脉冲组1.5±0.9次，p = 0.42），复发类型(葡萄膜前炎：脉冲组11%，半脉冲组17%，p = 0.33；后路炎症：脉冲组：34%，半脉冲组：22%，p = 0.14)两组间差异无统计学意义。在随访期间，脉冲组需要白内障手术的患者比例趋于较高（脉冲组：10%，半脉冲组：3%，p = 0.12），但差异无统计学意义。两组患者晚霞眼底发生率无显著差异（脉冲组23%，半脉冲组10%，p = 0.22）。结论：常规类固醇脉冲治疗与半脉冲治疗对VKH疾病的临床疗效无显著差异，半脉冲治疗通过减少类固醇总剂量，可能降低与皮质类固醇相关的不良反应的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Japanese Journal of Ophthalmology 医学-眼科学

CiteScore

4.80

自引率

8.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The Japanese Journal of Ophthalmology (JJO) was inaugurated in 1957 as a quarterly journal published in English by the Ophthalmology Department of the University of Tokyo, with the aim of disseminating the achievements of Japanese ophthalmologists worldwide. JJO remains the only Japanese ophthalmology journal published in English. In 1997, the Japanese Ophthalmological Society assumed the responsibility for publishing the Japanese Journal of Ophthalmology as its official English-language publication. Currently the journal is published bimonthly and accepts papers from authors worldwide. JJO has become an international interdisciplinary forum for the publication of basic science and clinical research papers.