May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Treatment of Ocular Mucous Membrane Pemphigoid With Immunosuppressive Drug Therapy
Author Affiliations & Notes
  • J. E. Thorne
    Ophthalmology, Johns Hopkins Wilmer Eye Inst, Baltimore, Maryland
  • F. Woreta
    Ophthalmology, Johns Hopkins Wilmer Eye Inst, Baltimore, Maryland
  • D. A. Jabs
    Ophthalmology, Johns Hopkins Wilmer Eye Inst, Baltimore, Maryland
  • G. J. Anhalt
    Dermatology, Johns Hopkins Univ School of Medicine, Baltimore, Maryland
  • Footnotes
    Commercial Relationships  J.E. Thorne, None; F. Woreta, None; D.A. Jabs, None; G.J. Anhalt, None.
  • Footnotes
    Support  EY 13707; RPB Harrington Special Scholars Award; M. Wiener Ocular MMP Research Fund
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 3238. doi:
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      J. E. Thorne, F. Woreta, D. A. Jabs, G. J. Anhalt; Treatment of Ocular Mucous Membrane Pemphigoid With Immunosuppressive Drug Therapy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3238.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To evaluate the effectiveness of immunosuppressive drug therapy in the treatment of ocular mucous membrane pemphigoid (MMP).

Methods: : All patients with biopsy-proven ocular MMP who were seen at the Mucous Membrane Pemphigoid Clinic at Wilmer Eye Institute from July 1984 to November 2006 were included in this study (n=94). Outcome measures included: 1) ocular disease control, defined as resolution of inflammation of the conjunctiva; 2) ocular remission, defined as no ocular disease activity for at least 3 months after the cessation of systemic immunosuppressive drug therapy, and; 3) ocular relapse, defined as recurrence of ocular disease after a remission of longer than three months duration. Treatment-related complications also were evaluated.

Results: : The incidences of ocular control, remission, and relapse were 1.03 (95% confidence interval [CI] 0.78, 1.33), 0.50 (95% CI 0.37, 0.67), and 0.04 (95% CI 0.02, 0.09) events per person-years, respectively. The estimated median time to ocular remission was ~14 months, and ~80% of patients achieved ocular remission 2 years after the initiation of immunosuppressive drug therapy. Characteristics associated with failing toachieve ocular remission in a univariate analysis were older age at presentation (relative risk [RR]=0.96, 95% CI 0.93, 0.99), trichiasis at presentation (RR=0.38, 95% CI 0.16, 090), prior eyelid surgery (RR=0.08, 95% CI 0.02, 0.48), 20/50 or worse visual acuity at presentation (RR=0.37, 95% CI 0.15, 0.92), and prior esophageal involvement (RR=0.29, 95% CI 0.10, 0.83). After adjusting for potentially confounding variables, an initial treatment regimen containing cyclophosphamide and prednisone was associated with a greater likelihood of achieving ocular remission (RR=8.53, 95% CI 2.53, 28.86, P = 0.001) when compared to all other initial treatment regimens. Anemia, hematuria, and infection were the most common side effects that developed in patients receiving cyclophosphamide therapy.

Conclusions: : In our cohort of patients with ocular MMP, the majority were able to achieve a complete ocular disease control on immunosuppressive drug therapy. Treatment with an initial treatment regimen containing cyclophosphamide and prednisone was associated with the development of ocular remission.

Keywords: autoimmune disease • clinical (human) or epidemiologic studies: outcomes/complications • immunomodulation/immunoregulation 
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