Disease Relapse After Drug-Free Remission in Ocular Mucous Membrane Pemphigoid

Shifera, Amde Selassie; Hong, Gloria; Khan, Irfan; Okeagu, Chinwenwa; Thorne, Jennifer E.

doi:10.1016/j.ajo.2020.09.029

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…Furthermore, stage progression at last visit was documented in 26% of eyes. There is a variable rate of OMMP progression reported by other authors, mostly due to the staging system used to classify the disease [4,14,[19][20][21]. Using the Foster criteria, You et al reported a shift from one stage to the next one in 8% of OMMP cases, which is signi cantly lower compared to our series [22].…”

Section: Discussioncontrasting

confidence: 67%

“…Shifera et al and Thorne et al reported a relapse rate of 17.6% and 18.2% among OMMP cases, respectively, which is signi cantly lower compared to ours[18,20]. There can be several reasons for such a difference with respect to our ndings.…”

contrasting

confidence: 79%

“…[4,19]. Oral prednisone is typically tapered over 3-4 months, whereas CTX is typically maintained for 12-18 months [19,20]. Some studies have shown a decreased recurrence rate with corticosteroids, also seen in our series [19,20].…”

Section: Discussionmentioning

confidence: 67%

“…Oral prednisone is typically tapered over 3-4 months, whereas CTX is typically maintained for 12-18 months [19,20]. Some studies have shown a decreased recurrence rate with corticosteroids, also seen in our series [19,20]. However, due to the high dose required to control in ammation, the risk of recurrence during drug tapering, and its adverse effect pro le with prolonged use, the use of systemic steroids alone is not recommended [26].…”

Section: Discussionmentioning

confidence: 93%

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The progression and therapeutic outcome of ocular mucous membrane pemphigoid in a Mexican-mestizo population

Colorado-Zavala

Ruiz-Lozano

Hernández-Camarena

et al. 2022

Preprint

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Purpose: To analyze the progression stage and therapeutic outcome of ocular mucous membrane pemphigoid (OMMP) in Mexican-mestizo patients. Methods: This is a single-center, retrospective study of OMMP patients. Ocular and extraocular manifestations, treatment, and visual acuity were recorded from all patients. Outcome measures, including inflammatory control at three months and disease progression, and recurrence were analyzed in patients who completed at least 6 months of follow-up time.Results: Forty-nine eyes from 25 patients (72% women) aged 67.2+11.1 years were initially included. At baseline, 2 (4.1%) eyes were classified as stage-I OMMP, whereas 11 (22.4), 34 (69.4%), and 2 (4.1%) eyes were classified as stages II, III, and IV, respectively. Twenty-seven eyes (14 patients) completed a follow-up time >6 months. Of those, 16 (59%) eyes achieved a complete response at three months under immunosuppressive therapy (IMT), 7 (26%) experienced stage progression, and 17 (63%) had at least one relapse. Mild disease activity (<2+ conjunctival inflammation) at baseline was significantly associated with achieving a complete response after 3 months of IMT (OR 18.0, 1.72–188.08). Systemic steroids were protective against disease relapse (OR 0.06, 0.01–0.60), whereas extraocular manifestations were identified as a risk factor for relapse (OR 10.13, 1.04–98.49). No associated factors with stage progression were found.Conclusions: We found that OMMP patients with extraocular manifestations had an increased risk of recurrent episodes of inflammation. Early and aggressive combined immunosuppression and a closer follow-up are necessary for these patients.

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Section: Discussioncontrasting

confidence: 67%

contrasting

confidence: 79%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 93%

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The progression and therapeutic outcome of ocular mucous membrane pemphigoid in a Mexican-mestizo population

Colorado-Zavala

Ruiz-Lozano

Hernández-Camarena

et al. 2022

Preprint

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“…Cyclophosphamide in combination with systemic steroids has traditionally been first-line for severe forms of OcMMP and has shown to be very effective in controlling disease progression. 2,20 In our study, cyclophosphamide was only used in the treatment of 1 patient. Notably, the patient developed a severe illness 2 months after initiating treatment and subsequently died.…”

Section: Discussionmentioning

confidence: 96%

A 10-Year Review of the Management of Ocular Mucous Membrane Pemphigoid: A Private Practice Experience

Johnson

Rosenbaum

Yarter

et al. 2022

Cornea

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Purpose: Ocular mucous membrane pemphigoid (OcMMP) is a rare and potentially blinding condition for which consensus treatment guidelines do not exist. The purpose of this study was to assess the effectiveness and safety of various immunomodulatory agents in the treatment of OcMMP in a private practice setting. Methods:We conducted a 10-year retrospective chart review of patients managed with OcMMP (n = 22). The median age at diagnosis was 73 (range: 35-91) years, and 59% (13/22) of patients were female. Visual acuity, Foster stage, and adverse effects (AEs) were documented. Treatment outcomes for each treatment episode were qualified at 3 months as complete response (CR), response (R), or failure (F). After 3 months, CR was then further subqualified as sustained CR, reactivation after initial CR, or AE after initial CR. The Fisher exact test P values were calculated for each outcome in comparison with mycophenolate.Results: Twenty patients were treated with an immunomodulatory agent for a total of 55 treatment episodes. In comparison to dapsone, mycophenolate was more likely to achieve sustained CR (50% vs. 0%, P = 0.022) and R (100% vs. 50%, P = 0.007), and less likely to fail (0% vs. 50%, P = 0.007). Dapsone was also more likely to be discontinued because of AEs than mycophenolate (40% vs. 6%, P = 0.041). Conclusions:Mycophenolate is a superior first-line agent to dapsone in the treatment of OcMMP. Although not statistically significant, mycophenolate trends toward superiority over methotrexate as well. Mycophenolate is very effective when used in combination with rituximab. Azathioprine remains a reasonable second-line agent.

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