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

Year: 2025

Type: article

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.

Source: Japanese Journal of Ophthalmology

DOI: 10.1007/s10384-025-01213-3