Effect of prednisone plus either adalimumab or cyclosporine on dermatological symptoms in Vogt-Koyanagi-Harada disease: Systemic outcomes from a randomized trial - 24/03/25

Doi : 10.1016/j.jaad.2025.02.081

Zhenyu Zhong, MD ^a, Jiayi Wang, MD ^a, Weiting Liao, MD ^a, Junjie Xiang, MSc ^a, Tao Cai, MD ^a, Peizeng Yang, MD ^a,^b,^⁎
^a Ophthalmology Medical Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing, China
^b The First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Henan International Joint Research Laboratory for Ocular Immunology and Retinal Injury Repair, Zhengzhou, China

^∗Correspondence to: Peizeng Yang, MD, The First Affiliated Hospital of Chongqing Medical University, Youyi Rd 1, Chongqing, 400016, China.The First Affiliated Hospital of Chongqing Medical UniversityYouyi Rd 1Chongqing400016China

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Abstract

Background

Vogt-Koyanagi-Harada (VKH) disease causes vitiligo, poliosis, and alopecia.

Objective

To investigate the effect of prednisone plus either adalimumab or cyclosporine-based immunosuppression on VKH dermatologic disorders using ancillary data from a VKH eye disease trial.

Methods

Patients with VKH disease treated with individualized prednisone tapering (maximum daily dose, 40 mg; maximum duration, 6 months) were randomized to adjunctive adalimumab (N = 54) or cyclosporine (N = 56). Outcomes included changes in vitiligo, poliosis, and alopecia at the sixth month.

Results

Overall, there was a decrease in the percentage of alopecia but no change in the presence of vitiligo or poliosis at the sixth month. The adalimumab group showed no nominally significant differences in the percentage changes of each dermatologic manifestation but a greater reduction in the number of affected dermatologic categories compared with the cyclosporine group.

Limitations

This is a secondary analysis of a VKH eye disease trial. Six-month follow-up may not fully assess effects on vitiligo and poliosis.

Conclusions

In conjunction with prednisone tapering, both adalimumab and cyclosporine similarily improved alopecia but had no obvious effect on the presence of vitiligo or poliosis at 6 months. Adalimumab was associated with a greater decrease in the number of affected dermatologic conditions compared with cyclosporine.

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Key words : adalimumab, cyclosporine, dermatologic symptoms, Vogt-Koyanagi-Harada disease

Abbreviations used : AUC, VKH

Plan

Introduction

Methods

Study design and participants

	Funding sources: The work was supported by National Natural Science Foundation Key Program (82230032 and 81930023), National Natural Science Foundation of China (82471059), Chongqing Key Project (CSTC2021jscx-gksb-N0010), Chongqing Medical Scientific Research Project: Joint Project of Chongqing Health Commission and Science and Technology Bureau (2025QNKX002), and China Postdoctoral Science Foundation (BX20230450 and 2024M763900). Dr Yang previously received funding from Occumension and Arctic Vision to conduct other clinical trials.
	Patient consent: Not applicable.
	IRB approval status: This trial was conducted in accordance with the provisions of the Declaration of Helsinki. Trial protocols were approved by The Ethics Committee of the First Affiliated Hospital of Chongqing Medical University.