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