甲氨蝶呤治疗眼瘢痕性类天疱疮的疗效

Methotrexate in the Treatment of Ocular Cicatricial Pemphigoid

目的:探讨应用甲氨蝶呤(MTX)治疗眼瘢痕性类天疱疮(OCP)的效果及安全性。方法:回顾性系列病例研究。收集2016年9月至2019年8月于天津医科大学总医院眼科行MTX治疗的OCP患者5例(10眼),其中男2例,女3例。观察MTX治疗6个月、12个月OCP炎症的进展及药物不良反应。结果:本组患者OCP平均发病年龄51.8岁(38~66岁),开始免疫治疗年龄54.4岁(39~68岁)。MTX治疗6个月,OCP好转3例,OCP部分活跃1例,OCP活跃1例。MTX治疗12个月,OCP好转4例,OCP活跃1例。活跃患者OCP睑球粘连进展,在MTX治疗12个月后加用利妥昔单抗联合治疗。治疗过程中,1人(1眼)在MTX治疗10个月时发生角膜病毒感染。另有2例应用MTX后出现轻度胃肠道反应,1例转氨酶轻度升高。随访期间无其他严重不良反应出现。结论:对于OCP患者,MTX耐受良好,早期应用有助于控制眼部病情。

Objective:To evaluate the effectiveness and safety of methotrexate(MTX)for the treatment of patients with ocular cicatricial pemphigoid(OCP).Methods:This was a retrospective case series study.A review of patient records with OCP who received treatment with MTX in the Department of Ophthalmology of Tianjin Medical University General Hospital from September 2016 to August 2019 were analyzed.Five patients were involved,2 males and 3 females.OCP inflammation and progression and the adverse reaction of MTX were evaluated.Results:Mean age at the onset of OCP was 51.8 years(range,38-66 years).Mean age at the initiation of immunotherapy was 54.4 years(range,39-68 years).Six eyes in 3 patients achieved quiescence,2 eyes in 1 patient presented with partial activity,and 2 eyes in 1 patient presented with disease activity after being treated by MTX for 6 months.At 12 months of MTX treatment,8 eyes in 4 patients achieved quiescence,and 2 eyes in 1 patient presented with disease activity and continuous progression over stage one of OCP.This patient received rituximab in combination with MTX at 12 months after MTX initiation.Adverse events included gastrointestinal reaction in 2 patients,mild liver enzyme elevation in 1 patient,and virus infection of the cornea of 1 eye in 1 patient after being treated with MTX for 10 months.No other severe adverse events were noted during the follow-up period.Conclusions:These retrospective data suggest that MTX is efficacious and well tolerated when included early in the treatment of OCP.