Outcome of treatment of uveitis with adalimumab in refractory cases of Vogt-Koyanagi-Harada disease

Objective The aim of this study was to assess the efficacy and safety of adalimumab in treating uveitis due to Vogt-Koyanagi-Harada (VKH) disease that did not respond adequately to treatment with antimetabolites. Patients and methods This is a prospective study that was conducted at the Uveitis Clinic of the Department of Ophthalmology in collaboration with the Department of Rheumatology, Physical Medicine, and Rehabilitation, Assiut University Hospital, Assiut, Egypt from January 2022 to January 2024. It included 20 patients diagnosed with VKH disease who showed inadequate response to antimetabolite therapy. The evaluation methods included assessment of uveitis control, best-corrected visual acuity expressed as logarithm of the minimum angle of resolution (LogMAR), intraocular pressure (IOP), macular thickness, and treatment-related side effects after a minimum of 6 months of adalimumab therapy. Results The mean age of the patients was 30.47±11.96 years, with 80% of the patients being adults, and with a female predominance [ n =11 (55%)]. Oral prednisone was used in all patients before the biologic treatment, with side effects in 17 (85%) patients, primarily weight gain. Adalimumab led to statistically significant improvements across multiple ocular parameters ( P <0.001). Uveitis was controlled in 70% of the patients by 1 month and remained stable throughout. Neurosensory detachment was present in 12 (60%) patients at baseline and decreased to two (10%) patients at 6 months. The central macular and choroidal thickness significantly decreased in both eyes by month 6 (the right eye median decreased from 355 to 202.5 μm and the left eye from 370 to 204 μm, P <0.001). The visual acuity improved from 1.10 Log MAR to 0.50 Log MAR in the right eye and from 1.30 to 0.80 Log MAR in the left eye, while the IOP decreased from 17.0to13.5 mmHg in the right eye and from 18.5 to14.0 mmHg in the left eye ( P <0.001 in both). Prednisolone was tapered from a median of 43.5 to a median of 7.5 mg/day. Adalimumab was well-tolerated with only one (5%) patient developing viral encephalitis and two (10%) patients were switched to baricitinib. Cataract occurred in 17 (85%) patients, IOP elevation in four (20%), choroidal neovascular membrane in four (20%), and keratic precipitates in four (20%) patients. Conclusion In VKH patients, adalimumab improved the visual outcomes and inflammation with a low rate of adverse events. These findings suggest that adalimumab may be an effective treatment option for VKH uveitis, offering an alternative to conventional methods, especially in resistant cases. Long-term studies are needed to confirm and improve the treatment strategies.