Systemic Chemotherapy for Ocular Cicatricial Pemphigoid

Tauber, Joseph; Maza, Maite Sainz de la; Foster, C. Stephen

doi:10.1097/00003226-199105000-00001

Cited by 131 publications

(77 citation statements)

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“…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: 99%

“…147 I have no experience of intravenous administration. 109 Tauber 1991: 105 patients. Combination therapy was used in 24% of patients at the end of follow up including dapsone ± prednisolone ± a myelosuppressive OR a myelopsuppressive + prednisolone.…”

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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“…The severity of MMP was scored in each patient according to the number of the involved anatomic sites and extension of active and cicatricial lesions using the conjunctival Tauber 32 grade for ocular involvement. The MMP severity was scored as "low" for patients having low activity in 1 or 2 sites other than the eye.…”

Section: Clinical and Routine Immunologic Datamentioning

confidence: 99%

Prevalence and Clinical Significance of Anti–Laminin 332 Autoantibodies Detected by a Novel Enzyme-Linked Immunosorbent Assay in Mucous Membrane Pemphigoid

Bernard

Antonicelli²,

Bédane³

et al. 2013

JAMA Dermatol

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Importance:A rare variant of mucous membrane pemphigoid (MMP) is characterized by circulating antilaminin 332 (Lam332) autoantibodies and seems to be associated with concurrent malignant neoplasms.Objective: To determine the prevalence and clinical significance of anti-Lam332 autoantibody detection from a large series of patients with MMP.Design: Multicenter retrospective study. Interventions: Serum samples were analyzed by a new Lam332 enzyme-linked immunosorbent assay (ELISA); clinical and immunopathologic data were obtained from the patients' medical records. Main Outcome Measures:The Lam332 ELISA scores were evaluated with respect to clinical characteristics, standard and salt-split indirect immunofluorescence, and bullous pemphigoid (BP) 230 and BP180-NC16A ELISAs.Results: The Lam332 ELISA score was positive (Ն9 U/mL) in 20.1% of serum samples from patients with MMP, 1 of 50 patients with bullous pemphigoid (BP), none of 7 with pemphigus, and 3 of 32 other controls. No relationship was evidenced between a positive ELISA Lam332 score and age; sex ratio; oral, ocular, genital, skin, or esophageal/laryngeal involvement; internal malignant neoplasm; or BP180 ELISA score. Salt-split skin indirect immunofluorescence and ELISA BP230 results were more frequently positive when Lam332 ELISA results were positive (P=.04 and .02, respectively). Patients with a positive Lam332 ELISA score frequently had more severe MMP (67.8% vs 47.2%; P=.04). Conclusions and Relevance:Results of this novel ELISA showed that serum anti-Lam332 autoantibodies are detected in 20.1% of patients with MMP. AntiLam332 autoantibodies are mainly detected in patients with severe MMP but not preferentially in those with a malignant neoplasm. The association between antiLam332 and anti-BP230 autoantibodies might arise from an epitope-spreading phenomenon.

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“…Early studies suggest that ocular MMP shows less progression when patients are immunosuppressed; treatment with cyclophosphamide in addition to oral corticosteroids seems to be more effective than, for example, azathioprine. [12][13][14][15][16]31 Recent trials report topical mitomycin to be beneficial in severe ocular MMP (14 patients) 39,40 ; Donnenfeld et al 40 describe no progression in 8 of 9 treated eyes vs progression in 5 of 9 untreated eyes (internal control). Intravenous immunoglobulins have been successfully used in one study of 10 patients with ocular MMP resistant to conventional treatment.…”

Section: Data Extractionmentioning

confidence: 99%

Interventions for Mucous Membrane Pemphigoid/Cicatricial Pemphigoid and Epidermolysis Bullosa Acquisita

Kirtschig

Murrell²,

Wojnarowska³

et al. 2002

Arch Dermatol

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Systemic Chemotherapy for Ocular Cicatricial Pemphigoid

Cited by 131 publications

References 0 publications

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

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

Prevalence and Clinical Significance of Anti–Laminin 332 Autoantibodies Detected by a Novel Enzyme-Linked Immunosorbent Assay in Mucous Membrane Pemphigoid

Interventions for Mucous Membrane Pemphigoid/Cicatricial Pemphigoid and Epidermolysis Bullosa Acquisita

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