Abstract： Objective: To evaluate the effectiveness and safety of methotrexate (MTX) for the treatment of patients with ocular cicatricial pemphigoid (OCP). Methods: This was a retrospective case series study. A review of patient records with OCP who received treatment with MTX in the Department of Ophthalmology of Tianjin Medical University General Hospital from September 2016 to August 2019 were analyzed. Five patients were involved, 2 males and 3 females. OCP inflammation and progression and the adverse reaction of MTX were evaluated. Results: Mean age at the onset of OCP was 51.8 years (range, 38-66 years). Mean age at the initiation of immunotherapy was 54.4 years (range, 39-68 years). Six eyes in 3 patients achieved quiescence, 2 eyes in 1 patient presented with partial activity, and 2 eyes in 1 patient presented with disease activity after being treated by MTX for 6 months. At 12 months of MTX treatment, 8 eyes in 4 patients achieved quiescence, and 2 eyes in 1 patient presented with disease activity and continuous progression over stage one of OCP. This patient received rituximab in combination with MTX at 12 months after MTX initiation. Adverse events included gastrointestinal reaction in 2 patients, mild liver enzyme elevation in 1 patient, and virus infection of the cornea of 1 eye in 1 patient after being treated with MTX for 10 months. No other severe adverse events were noted during the follow-up period. Conclusions: These retrospective data suggest that MTX is efficacious and well tolerated when included early in the treatment of OCP.
Ahmed M, Zein G, Khawaja F, et al. Ocular cicatricial pemphigoid: Pathogenesis, diagnosis and treatment. Prog Retin Eye Res, 2004, 23(6): 579-592. DOI: 10.1016/j.preteyeres.2004.05.005.
Foster CS, Wilson LA, Ekins MB. Immunosuppressive therapy for progressive ocular cicatricial pemphigoid. Ophthalmology, 1982, 89(4): 340-353. DOI: 10.1016/s0161-6420(82)34791-0.
[5]
Georgoudis P, Sabatino F, Szentmary N, et al. Ocular mucous membrane pemphigoid: Current state of pathophysiology, diagnostics and treatment. Ophthalmol Ther, 2019, 8(1): 5-17. DOI: 10.1007/s40123-019-0164-z.
[6]
You C, Ma L, Anesi SD, et al. Long-term remission of ocular cicatricial pemphigoid off immunomodulatory therapy. Eur J Ophthalmol, 2018, 28(2): 157-162. DOI: 10.5301/ejo.5001050.
[7]
Kirtschig G, Murrell D, Wojnarowska F, et al. Interventions for mucous membrane pemphigoid/cicatricial pemphigoid and epidermolysis bullosa acquisita: A systematic literature review. Arch Dermatol, 2002, 138(3): 380-384. DOI: 10.1001/ archderm.138.3.380.
[8]
Saw VP, Dart JK, Rauz S, et al. Immunosuppressive therapy for ocular mucous membrane pemphigoid strategies and outcomes. Ophthalmology, 2008, 115(2): 253-261. DOI: 10.1016/j.ophtha. 2007.04.027.
You C, Lamba N, Lasave AF, et al. Rituximab in the treatment of ocular cicatricial pemphigoid: A retrospective cohort study. Graefes Arch Clin Exp Ophthalmol, 2017, 255(6): 1221-1228. DOI: 10.1007/s00417-017-3603-3.
[11]
Ma L, You C, Hernandez M, et al. Management of ocular cicatricial pemphigoid with intravenous immunoglobulin monotherapy. Ocul Immunol Inflamm, 2019, 27(4): 636-642. DOI: 10.1080/09273948.2018.1433302.
[12]
Foster CS, Chang PY, Ahmed AR. Combination of rituximab and intravenous immunoglobulin for recalcitrant ocular cicatricial pemphigoid: a preliminary report. Ophthalmology, 2010, 117(5): 861-869. DOI: 10.1016/j.ophtha.2009.09.049.
[13]
You C, Sahawneh HF, Ma L, et al. A review and update on orphan drugs for the treatment of noninfectious uveitis. Clin Ophthalmol, 2017, 11: 257-265. DOI: 10.2147/OPTH.S121734.
[14]
Gangaputra S, Newcomb CW, Liesegang TL, et al. Systemic immunosuppressive therapy for eye diseases cohort study. Methotrexate for ocular inflammatory diseases. Ophthalmology, 2009, 116(11): 2188-2198. DOI: 10.1016/j.ophtha.2009.04.020.
[15]
Rübsam A, Stefaniak R, Worm M, et al. Rituximab preserves vision in ocular mucous membrane pemphigoid. Expert Opin Biol Ther, 2015, 15(7): 927-933. DOI: 10.1517/14712598.2015. 1046833.
浙公网安备 33030202001892号