Efficacy and adverse reactions of methotrexate in the treatment of ocular cicatricial pemphigoid: A case series study

Abstract

The application of methotrexate (MTX) in the treatment of autoimmune diseases has been gradually increasing, but reports of MTX treatment for advanced ocular cicatricial pemphigoid (OCP) are extremely rare. This study investigated the efficacy and adverse reactions of low-dose MTX in patients with OCP.This was a retrospective, noncontrolled, case series study. Eleven patients diagnosed with advanced OCP (4 cases in stage III and 7 cases in stage IV) were enrolled. Treatment by oral administration of MTX (7.5 ± 2.5 mg) alone was performed. Visual acuity of the patients, conjunctival inflammation, cicatrization, ocular surface keratinization, and toxic side effects of drugs were evaluated.All patients enrolled in this study were females aged 32 to 83 years. Patients were followed up for 4 to 33 months. Low-dose MTX improved visual acuity of 3 cases (6 eyes, 27.3%). Conjunctival inflammation of 5 patients (10 eyes) rested after treatment, and conjunctival inflammation of 3 cases (6 eyes, 27.3%) was decreased with an effective rate of 72.7%. Cicatrices of 8 cases (15 eyes) showed degeneration after treatment with an effective rate of 71.4% (15/21). Ocular surface keratinization receded in 4 cases with an effective rate of 66.7%. None of the patients discontinued the treatment due to severe toxic side effects. All patients tolerated mild drug-induced gastrointestinal reactions. Three patients terminated the treatment in advance after 4 to 6 months due to no improvement in the disease condition.Observation of clinical efficacy and safety findings demonstrated that low-dose MTX can be used to treat patients with advanced OCP.

Figure 1

(Case 3) Before the treatment, we could obviously see the keratinization (A arrow) and conjunctivialization (B arrow) on the corneal. Conjunctiva appeared proliferation (C arrow). The light cannot reach anterior chamber through the corneal. After the treatment for 19 months, keratinization of corneal was partly reversed (A arrow), conjunctivialization had faded (B arrow). The proliferation on the conjunctiva was improved and angle of sclera edge could be identified (D arrow). And the iris was visible through corneal.

Figure 2

(Case 4) Before the treatment, conjunctiva appeared proliferation (A arrow). We could obviously see the keratinization (B arrow) on the corneal. The light cannot reach anterior chamber through the corneal. After the treatment for 29 months, conjunctivialization had faded (A arrow), keratinization of corneal was partly reversed (B arrow). And the iris was visible through corneal (C arrow).

Figure 3

(Case 11) Before the treatment, we could obviously see the conjunctival adhesion (A arrow), conjunctival hyperemia (B arrow) and lots of viscous secretions (C arrow). After the treatment for 6 months, conjunctival adhesion was released (A arrow), conjunctival hyperemia was alleviated (B arrow), and secretions were decreased (C arrow).

Figure 4

(Case 7) Before the treatment, it showed that the patient suffered from severe conjunctival adhesion (A arrow). After the treatment for 4 months, conjunctival hyperplasia became more serious (A arrow). The right corneal appeared obviously conjunctivialization (B arrow) and conjunctival sac constriction (C arrow).