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

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.