To evaluate whether long-term remission of ocular cicatricial pemphigoid (OCP) after withdrawal of immunomodulatory therapy (IMT) is possible.
A total of 34 of 464 presenting patients (66 eyes) with biopsy-proven OCP in long-term remission off IMT were identified after finishing a 2-year IMT regimen without active disease (2005-2015). Long-term remission off IMT for OCP was defined as patients withdrawn from IMT ≥1 year lacking clinically detectable progressive scarring according to Foster staging and subjective assessment.
All 34 patients achieved ≥1 year of clinical remission without IMT following 2 years IMT lacking active disease. Mean onset age of OCP was 67.0 years, and median follow-up time was 63.4 months. Mean duration between OCP onset and IMT initiation was 29.5 months, with a mean sustained remission time of 36.0 months off IMT. The mean duration of IMT prior to remission off IMT was 34.8 months (median 32 months, IQR 27-39.5 months). Commonly, methotrexate was used prior to OCP remission (19 patients; 55.9%). Two patients experienced mild flare-up postremission off IMT at months 25 and 37 and a course of topical steroid appeared to resolve the inflammation. Another patient had active inflammation at last office visit 5 years after discontinuation of IMT and will restart IMT.
Long-term remission for OCP off IMT may be achieved after stepladder IMT is implemented and withdrawn. Longer follow-up and more sensitive measures of scarring and inflammation are needed to generate a consensus on the definition of complete remission and on cessation of systemic IMT for OCP.
Post author correction
Article Type: ORIGINAL RESEARCH ARTICLE
Article Subject: Conjunctivitis
AuthorsCaiyun You, Lina Ma, Stephen D. Anesi, C. Stephen Foster
- • Accepted on 20/09/2017
- • Available online on 14/10/2017
This article is available as full text PDF.
- You, Caiyun [PubMed] [Google Scholar] 1, 2, 3
- Ma, Lina [PubMed] [Google Scholar] 1, 2
- Anesi, Stephen D. [PubMed] [Google Scholar] 1, 2
- Foster, C. Stephen [PubMed] [Google Scholar] 1, 2, 4, * Corresponding Author (email@example.com)
Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, MA - USA
Ocular Immunology and Uveitis Foundation, Weston, MA - USA
Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin - China
Department of Ophthalmology, Harvard Medical School, Boston, MA - USA