Original articleMethotrexate therapy for 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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2022, Ocular SurfaceCitation Excerpt :In one study, withdrawal of the inciting drug stopped the progression of the disease in 4/5 patients but continued to progress in one patient despite drug withdrawal, probably reflecting drug-induced or concurrent MMP [32]. Low-dose (5–25 mg) oral methotrexate monotherapy in 5 patients with drug-induced MMP (one biopsy positive) controlled ocular surface inflammation and prevented cicatrization progression [38]. These subjects have what we have termed progressive DICC which we currently consider to be synonymous with drug-induced/associated immunopathology negative ocular MMP [1] and which should be treated in the same way.
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Manuscript no. 230126.
The authors have no commercial interest in any drugs mentioned in this study.