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Caiyun You, Lina Ma, Stephen D Anesi, C. Stephen Foster; Long-term Complete Remission of Ocular Cicatricial Pemphigoid off Immunomodulatory Therapy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):504.
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© ARVO (1962-2015); The Authors (2016-present)
Whether ocular cicatricial pemphigoid (OCP) treated with stepladder immunomodulatory therapy (IMT) can achieve complete remission is not clear. We performed a retrospective, observational clinical study to evaluate the possibility of long-term complete remission of OCP after withdrawal of IMT.
The authors studied the long-term remission off IMT in 34 patients with biopsy proven OCP between January 2005 and October 2015, 25 men and 9 women . The mean age at onset for OCP was 67.0 years. The long-term complete remission off IMT for OCP was defined as patients with OCP who were withdrawn off IMT for at least 1 year with absence of progressive scarring and active ocular inflammation. The average follow up was 5 years. Demographic, treatment regimen, conjunctival inflammation, stage of OCP (Foster), and best corrected visual acuity were recorded.
All 34 patients achieved a clinical long-term remission without IMT. Average sustained remission time was 3 years (from 1 year to 6.5 years) while not undergoing IMT. Last treatment regimens for gaining OCP remission included methotrexate in 18 patients (52.9%), mycophenolate mofetil in 8 patients (23.5%), cytosine arabinoside in 4 patients (11.8%), intravenous immunoglobulin in 2 patients (5.9%), azathioprine and rituximab with intravenous immunoglobulin in 1 each patient (2.9%). No cicatrization progression or worsening of visual acuity were observed during the follow up period.
Long-term remission for OCP off IMT could be achieved after proper stepladder IMT and withdrawal regimens. Further assessment with longer follow up are needed for a unified consensus on definition of a complete remission and on end points of systemic IMT for OCP.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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