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Available online 2 June 2021
Ocular cicatricial pemphigoid: Methotrexate as an initial treatment?
Penfigoide ocular cicatricial: ¿metotrexato como tratamiento de inicio?
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Andrea María Smichowski
Corresponding author
andreasmichowski@hotmail.com

Corresponding author.
, Victor Daniel Caputo, Cecilia Romeo, Estela Rivero, Natalia Soledad Morales, Gustavo Casado
Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
Received 05 June 2020. Accepted 15 October 2020
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Table 1. Demographic, clinical and laboratory data of patients with cicatricial ocular pemphigoid.
Table 2. Treatments offered.
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Abstract
Objective

To analyse the clinical/epidemiological data, the management and the treatments established in patients with Ocular Cicatricial Pemphigoid (OCP) in a Rheumatology Service.

Material and methods

Review of clinical histories of patients with OCP referred by ophthalmology between 2008 and 2019.

Results

In our series of 27 patients, 67% were diagnosed and referred in the last 2 years. Most in Foster stage 1. Of the patients, 18.5% presented associated Sjogren's syndrome, with poor progression: 88.8% received Methotrexate, 74% used it as monotherapy and 66% continued with said treatment up to the end. Eighteen point five percent had to combine or rotate therapies, the drugs used were mycophenolate, azathioprine, cyclophosphamide, sirolimus, etanercept, rituximab: 29% used steroids. Only in 2 eyes was stage progression observed. There were no serious adverse events, and 37% had mild adverse events.

Conclusion

Starting immunosuppressive therapy early is essential, methotrexate being a good initial alternative in our experience, and treatment must be escalated in line with disease progression.

Keywords:
Ocular cicatricial pemphigoid
Methotrexate
Treatment
Resumen
Objetivo

Analizar los datos clínicos/epidemiológicos, el manejo y los tratamientos instaurados a pacientes con Penfigoide Ocular Cicatricial (POC) en un Servicio de Reumatología.

Material y métodos

Revisión de historias clínicas de pacientes con POC derivados por oftalmología entre 2008 y 2019.

Resultados

En nuestra serie de 27 pacientes, 67% fue diagnosticado y derivado en los últimos 2 años. La mayoría en estadío 1 de Foster. El 18,5% presentó Síndrome de Sjogren asociado, conllevando a una evolución desfavorable. El 88,8% recibieron Metotrexato, 74% lo utilizaron en monoterapia y 66% continuaron el tratamiento hasta el final. El 18,5% debió combinar/rotar terapias, las drogas utilizadas fueron micofenolato, azatioprina, ciclofosfamida, sirolimus, rituximab. El 29% utilizó esteroides. Solo en 2 ojos progresó el estadío. No se registraron eventos adversos serios y 37% presentó eventos adversos leves.

Conclusión

El inicio temprano de la terapia inmunosupresora es fundamental, siendo el metotrexato una buena alternativa como tratamiento de inicio según nuestra experiencia, debiendo escalar el tratamiento de acuerdo a la evolución.

Palabras clave:
Penfigoide ocular cicatricial
Metotrexato
Tratamiento

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