Methotrexate therapy for ocular cicatricial pemphigoid

Area of Science:

• Ophthalmology
• Rheumatology
• Dermatology

Background:

• Ocular-cicatricial pemphigoid (OCP) and drug-induced OCP are chronic inflammatory conditions causing progressive conjunctival scarring and vision loss.
• First-line systemic therapy is crucial for managing these debilitating diseases and preventing irreversible ocular damage.

Purpose of the Study:

• To evaluate the efficacy and safety of low-dose oral methotrexate as a first-line systemic therapy for OCP and drug-induced OCP.
• To assess methotrexate's impact on conjunctival inflammation, cicatrization progression, and visual acuity.

Main Methods:

• Retrospective, noncomparative, interventional case series.
• Analysis of clinical data from 17 patients (12 OCP, 5 drug-induced OCP) treated with methotrexate monotherapy.
• Outcomes measured included visual acuity, conjunctival inflammation, cicatrization, and side effects.

Main Results:

• Methotrexate monotherapy achieved high rates of conjunctival inflammation control (89% OCP, 100% drug-induced OCP).
• Progression of conjunctival cicatrization was prevented in a majority of eyes (72% OCP, 90% drug-induced OCP).
• Visual acuity was maintained or improved in 85% of eyes, with 74% achieving 6/18 or better.

Conclusions:

• Low-dose oral methotrexate is a highly effective and well-tolerated first-line systemic treatment for OCP and drug-induced OCP.
• Methotrexate monotherapy demonstrates significant benefits in controlling inflammation and preventing disease progression.
• The favorable safety profile supports its use as an initial therapeutic option for these conditions.