A COVID-19 Risk Reduction Strategy for the Treatment of Acute Vogt-Koyanagi-Harada Disease Utilizing the Antiviral Potential of Cyclosporine

ABSTRACT

Purpose

To report on the successful treatment of patients with acute Vogt-Koyanagi-Harada (VKH) disease utilizing the antiviral potential of cyclosporine during the COVID-19 pandemic.

Study Design

Case series.

Methods

Clinical records were retrospectively reviewed of 4 patients presenting with new-onset acute VKH disease who elected to receive initial treatment consisting of bilateral sub-Tenon injection of triamcinolone acetonide combined with immediately starting oral cyclosporine without the use of systemic corticosteroids.

Results

The mean follow-up was 17.0 months. Choroidal thickness decreased to normal with recovery of bilateral best-corrected visual acuity (BCVA) of 1.2 in 3 patients. One elderly patient had decreased BCVA (OD 0.5, OS 0.8) due to cataract progression and mild epiretinal membrane. No recurrences of intraocular were observed in any patients. Mild renal dysfunction developed in 2 elderly patients, but importantly no patients developed COVID-19 disease.

Conclusions

Oral cyclosporine as the initial systemic treatment of acute VKH disease, in combination with sub-Tenon injection of triamcinolone acetonide, lead to favorable clinical outcomes. Due to the known antiviral properties of cyclosporine, we suggest that this may represent a good treatment strategy for patients during the COVID-19 pandemic.

KEYWORDS:

• Coronavirus
• COVID-19
• Vogt-Koyanagi-Harada Disease
• cyclosporine
• triamcinolone acetonide

Disclosure statement

AAO: research funds (Alcon Pharma Japan, Bayer Japan, Kowa, Mitsubishi Tanabe Pharma); consultant fees (Bayer Healthcare, Bayer Japan, Biocon Biologics, Chugai, Hoya, Kowa, Novartis Japan, Novartis Pharma); lecture fees (Abbvie Japan, Alcon Pharma Japan, Allergan Japan, Bayer Japan, Kowa, Mitsubishi Tanabe Pharma, Novartis Japan, Otsuka Pharmaceutical, Pfizer Japan, Santen Pharmaceutical, Senju Pharmaceutical).

HK: research funds (Mitsubishi Tanabe Pharma), lecture fees (Bayer Japan, Carl Zeiss Meditec (Germany), Kowa, Mitsubishi Tanabe Pharma, Nikon, Novartis Pharma, Santen Pharmaceutical, Bayer and Senju Pharmaceutical).

MN, IH, YA, TW: none.

Additional information

Funding

This work was not supported by any funding agency in the public, commercial or not-for-profit sectors.