Adalimumab vs cyclosporine: Which is better for dermatological symptoms in VKH disease?

Immunosuppression with prednisone plus either adalimumab or cyclosporine is effective in improving alopecia, but neither treatment does not provide any significant impact on the presence of vitiligo or poliosis in patients with Vogt-Koyanagi-Harada (VKH) disease at 6 months, reports a study.

Overall, the percentage of alopecia decreased, but there was no change in the presence of vitiligo or poliosis by month 6. Patients treated with adalimumab did not show nominally significant differences in the percentage changes of each dermatologic manifestation. However, they had a greater decrease in the number of affected dermatologic categories than those who received cyclosporine.

“Adalimumab was associated with a greater decrease in the number of affected dermatologic conditions compared with cyclosporine,” the investigators said.

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

A team of investigators randomized patients with VKH disease treated with individualized prednisone tapering (maximum daily dose 40 mg; maximum duration 6 months) to either adjunctive adalimumab (n=54) or cyclosporine (n=56). They assessed outcomes such as changes in vitiligo, poliosis, and alopecia at 6 months.

The study was limited by its design as a secondary analysis of a previous trial. In addition, it had a short follow-up time, which might not be enough to fully examine the effects on vitiligo and poliosis.

“VKH disease causes vitiligo, poliosis, and alopecia,” the investigators said.