Long term results of systemic chemotherapy for ocular cicatricial pemphigoid

Foster, C. Stephen; Neumann, Ron; Tauber, Joseph

doi:10.1007/bf00160769

Cited by 65 publications

(66 citation statements)

References 10 publications

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“…Lifelong follow-up is necessary, because disease recurs in up to 1/3 of patients. 105 Our series of 115 patients showed remission without therapy of at least 6 months in 20 (17%) of patients with a relapse in 4/20 (20%). In our experience Cyclophosphamide dose and malignancy: The dose of cyclophosphamide is given as between 1.0-2.0 mg/kg in the different studies and reviews summarized in rows 14-18.…”

Section: Use Of Systemic Immunomodulation To Control Immunemediated Imentioning

confidence: 65%

“…Evidence for the efficacy of different immunosuppressive regimens in controlling inflammation and guidelines for its delivery Evidence for the effect of current immunosuppressive therapy in ocular MMP is summarised in Table 4 and comes from cohort studies, 100,101 interventional and retrospective case series 43,84,92,[102][103][104][105][106][107][108][109][110] and two randomized trials. 23 These have indicated a role for dapsone, sulfasalazine or sulphapyridine for mild to moderate inflammation, azathioprine, mycophenolate or methotrexate for moderate inflammation, or for disease not responding to sulphonamide therapy, and cyclophosphamide with a short course of prednisolone, for severe inflammation.…”

Section: Use Of Systemic Immunomodulation To Control Immunemediated Imentioning

confidence: 99%

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The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on

Dart

2017

Eye

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This review is in two sections. The first section summarises 35 conditions, both common and infrequent, causing cicatrising conjunctivitis. Guidelines for making a diagnosis are given together with the use of diagnostic tests, including direct and indirect immunofluorescence, and their interpretation. The second section evaluates our knowledge of ocular mucous membrane pemphigoid, which is the commonest cause of cicatrizing conjunctivitis in most developed countries. The clinical characteristics, demographics, and clinical signs of the disease are described. This is followed by a review and re-evaluation of the pathogenesis of conjunctival inflammation in mucous membrane pemphigoid (MMP), resulting in a revised hypothesis of the autoimmune mechanisms causing inflammation in ocular MMP. The relationship between inflammation and scarring in MMP conjunctiva is described. Recent research, describing the role of aldehyde dehydrogenase (ALDH) and retinoic acid (RA) in both the initiation and perpetuation of profibrotic activity in MMP conjunctival fibroblasts is summarised and the potential for antifibrotic therapy, using ALDH inhibition, is discussed. The importance of the management of the ocular surface in MMP is briefly summarised. This is followed with the rationale for the use of systemic immunomodulatory therapy, currently the standard of care for patients with active ocular MMP. The evidence for the use of these drugs is summarised and guidelines given for their use. Finally, the areas for research and innovation in the next decade are reviewed including the need for better diagnostics, markers of disease activity, and the potential for biological and topical therapies for both inflammation and scarring.

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Section: Use Of Systemic Immunomodulation To Control Immunemediated Imentioning

confidence: 65%

Section: Use Of Systemic Immunomodulation To Control Immunemediated Imentioning

confidence: 99%

The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on

Dart

2017

Eye

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“…É difícil fazer uma melhor avaliação sobre este aspecto, devido ao número resumido de olhos no estágio I e II, apenas 1 em cada grupo (Tabela 1). Apesar do diagnóstico do PCO ser clínico, a comprovação laboratorial deve ser realizada, para que a terapêutica seja instituída o mais breve e com a maior segurança possível (7,11) . Vários métodos têm sido propostos para auxiliar o diagnóstico do PCO, mas nenhum específico.…”

Section: Discussionunclassified

Imunofluorescência direta no diagnóstico de casos suspeitos de penfigóide cicatricial ocular

Donato

Santos

et al. 2003

Arq. Bras. Oftalmol.

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Objetivos: O objetivo deste estudo é caracterizar por meio do exame oftalmológico os pacientes com suspeita clínica de penfigóide cicatricial ocular e apresentar os resultados obtidos com a técnica de imunofluorescên-cia direta. Métodos: Estudo prospectivo realizado no setor de Córnea e Doenças Externas da Universidade Federal de São Paulo. Foram examinados 18 pacientes com suspeita clínica de penfigóide cicatricial ocular e realizadas biópsias de conjuntiva para o processamento da imunofluorescência direta em 13 pacientes (26 olhos), que não estavam na vigência de imunossupressão sistêmica ou terapêutica antiglaucomatosa tópica. Resultados: Segundo o estadiamento de Foster, a proporção de olhos classificados de I a IV foram: 3,8%, 3,8%, 77%, 15,4% respectivamente. Apenas 3 (23%) pacientes apresentaram imunofluorescência direta positiva. Conclusão: A maioria dos pacientes encontravam-se em estágio avançado da doença, o que denota retardo no diagnóstico. A imunofluorescência direta apresentou baixa sensibilidade em detectar depósitos de imunocomplexos na membrana basal da conjuntiva, quando comparada aos dados da literatura.

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“…As with other autoimmune disorders, immunomodulatory drugs have been employed in treatment of OCP. Therapy of OCP with systemic steroids [1] and immunosuppressive agents such as dapsone [5], methotrexate [5], azathioprine [6], and cyclophosphamide [6] is described in the literature. Recently, intravenous immunoglobulin therapy was reported in patients with OCP recalcitrant to conventional immunomodulators [7].…”

Section: Introductionmentioning

confidence: 99%