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Ocular cicatricial pemphigoid: Methotrexate as an initial treatment?
Andrea María Smichowski1, Victor Daniel Caputo1, Cecilia Romeo1
1Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina.
Reumatologia Clinica
|June 5, 2021
Summary
Early immunosuppressive therapy for Ocular Cicatricial Pemphigoid (OCP) is crucial. Methotrexate is an effective initial treatment, with escalation guided by disease progression.
Area of Science:
- Rheumatology
- Ophthalmology
- Immunology
Background:
- Ocular Cicatricial Pemphigoid (OCP) is a chronic autoimmune blistering disease affecting the eyes.
- Early diagnosis and management are critical to prevent vision loss.
Observation:
- A review of 27 OCP patients managed in a Rheumatology Service between 2008-2019.
- Most patients were diagnosed and referred within the last two years of the study period, often presenting at early Foster stages.
- Associated Sjogren's syndrome was noted in 18.5% of patients.
Findings:
- Methotrexate was the primary immunosuppressive agent, used by 88.8% of patients, often as monotherapy (74%) and continued long-term by 66%.
- Disease progression was minimal, with only 2 eyes showing stage advancement.
- 18.5% required therapy modification, utilizing mycophenolate, azathioprine, cyclophosphamide, sirolimus, etanercept, or rituximab. Steroids were used in 29% of cases.
- Adverse events were generally mild (37%), with no serious events reported.
Implications:
- Prompt initiation of immunosuppressive therapy is vital for managing OCP.
- Methotrexate demonstrates efficacy as a first-line treatment for OCP.
- Treatment strategies should be individualized and adjusted based on disease activity and progression.
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