Elsevier

Ophthalmology

Volume 111, Issue 4, April 2004, Pages 796-801
Ophthalmology

Original article
Methotrexate therapy for ocular cicatricial pemphigoid

https://doi.org/10.1016/j.ophtha.2003.07.010Get rights and content

Abstract

Purpose

To report the use of methotrexate therapy as first-line systemic therapy in the treatment of ocular-cicatricial pemphigoid and drug-induced ocular-cicatricial pemphigoid.

Design

Retrospective, noncomparative, interventional case series.

Participants

Twelve patients with ocular-cicatricial pemphigoid and 5 patients with drug-induced ocular-cicatricial pemphigoid treated with low-dose oral methotrexate as the sole systemic agent. In 14 of the 17 patients, methotrexate was the first systemic agent used.

Methods

Clinical data abstracted from patient medical records.

Main outcome measures

Visual acuity, conjunctival inflammation, progression of cicatrization, and treatment-related side effects.

Results

After a mean follow-up duration of 30.2 months (range, 6–78 months), complete control or suppression, or both, of conjunctival inflammation was achieved in 89% of eyes with ocular-cicatricial pemphigoid and in 100% of eyes with drug-induced ocular-cicatricial pemphigoid using methotrexate monotherapy as the first-line systemic agent. Progression of conjunctival cicatrization was prevented in 72% of eyes with ocular-cicatricial pemphigoid and 90% of eyes with drug-induced ocular-cicatricial pemphigoid. Visual acuity was maintained or improved in 85% of total eyes treated with methotrexate monotherapy, and a final visual acuity of 6/18 or better was achieved in 74% of the eyes. Methotrexate therapy was well tolerated, with 92% of patients maintained on continued treatment experiencing no side effects. The most common side effects were gastrointestinal (50%), and most (78%) were reversible on dose reduction. In 4 of 17 cases, methotrexate was ceased as a result of possible treatment-related side effects.

Conclusions

Low-dose oral methotrexate monotherapy is both highly efficacious and well tolerated as the first-line systemic agent in the treatment of ocular-cicatricial pemphigoid and drug-induced ocular-cicatricial pemphigoid.

Section snippets

Patients and methods

We retrospectively reviewed the clinical records of 25 consecutive patients with OCP or drug-induced OCP treated with MTX at the Ocular Immunology Clinic, St. Vincent's Hospital, Sydney, between January 1996 and July 2002.

The inclusion criteria were clinical diagnosis of OCP or drug-induced OCP with adequate data, systemic treatment with low-dose oral MTX monotherapy, and follow-up by the investigators for a minimum of 6 months after the initiation of MTX therapy. The exclusion criteria were

Results

Seventeen patients met the inclusion criteria and were analyzed in the study. All patients were followed up for at least 6 months after initiation of MTX therapy; no patients were excluded from the study because of early discontinuation of MTX therapy secondary to treatment-related side effects. Eight patients were excluded because they were treated concurrently with systemic immunosuppressive agents in addition to MTX. A total of 34 eyes of the 17 patients treated with systemic low-dose oral

Discussion

This study reports the successful treatment of OCP and drug-induced OCP with oral low-dose weekly MTX monotherapy. Complete control or suppression of conjunctival inflammation, or both, was achieved in 89% of eyes with OCP and 100% of eyes with drug-induced OCP. This therapy achieved complete prevention of the progression of conjunctival cicatrization in 72% of eyes with OCP and 90% of eyes with drug-induced OCP. Visual acuity was maintained or improved in 85% of total eyes treated with MTX

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    The authors have no commercial interest in any drugs mentioned in this study.

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