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Anti-TNFα therapy and switching in severe uveitis related to Vogt-Koyanagi-Harada syndrome.

The study aimed to describe the effectiveness of switching the anti-TNFα agent when an acceptable clinical response has not been obtained with the first anti-TNFα agent in patients with uveitis in VKH syndrome. Patients diagnosed with VKH syndrome being evaluated from the uveitis unit of a single tertiary hospital from January 1, 2000, to October 30, 2015. Patients who presented uveitis with an inadequate response to a first anti-TNFα and required switching to a second anti-TNFα were selected. Complete clinical response was assumed in patients whose visual acuity was normal and those who showed absence of inflammatory findings (inflammatory cells in the anterior chamber and vitritis) or absence of macular thickening in upon OCT. A systematic review of the literature of anti-TNFα agents in VKH syndrome was performed. Five patients met the criteria of VKH syndrome. Two cases of VKH syndrome with uveitis and inadequate clinical response to an initial anti-TNFα (both IFX) were presented. After switching to Adalimumab (ADA), a satisfactory clinical response was noted in the first month. For the first time, we present two patients with severe uveitis due to VKH syndrome who after inadequately responding to the first anti-TNFα agent showed complete and maintained clinical improvement when switched to a second anti-TNFα agent.