Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts 02142, USA.
Ophthalmology. 2010 May;117(5):861-9. doi: 10.1016/j.ophtha.2009.09.049. Epub 2010 Jan 4.
To compare the effectiveness and safety of the combination therapy of rituximab (RTX) and intravenous immunoglobulin (IVIg) to other immunosuppressive regimens in the treatment of ocular cicatricial pemphigoid (OCP).
Retrospective, comparative, interventional case series.
Twelve patients with OCP.
We reviewed medical records of 12 patients with OCP. Ten of the 12 patients were blind in 1 eye after initial systemic immunosuppressive therapies (phase 1 treatment). The patients were then divided into 2 groups based on treatments received during phase 2. The study group consisted of 6 patients who received the combination of RTX and IVIg during phase 2 of their treatment. For comparison purposes, the control group consisted of 6 patients who during phase 2 of their treatment received more aggressive immunosuppressive therapies, but not RTX and IVIg, because the insurance carriers refused to pay for the combination therapy.
Blindness (best-corrected visual acuity [BCVA] < or =20/200) and OCP staging (Foster).
The median total follow-up periods were 57.5 and 55.5 months in the control group and the study group, respectively. After phase 1 treatment, all 6 patients in the control group were blind in 1 eye. Similarly, 4 of the patients in the study group were blind in 1 eye, whereas 2 had good BCVA bilaterally but experienced persistent conjunctival inflammation despite phase 1 treatment. After phase 2 treatment, all 6 patients in the control group had OCP progression and became blind in both eyes. In contrast, BCVA was stable and no further progression of OCP staging was observed in all 6 patients in the study group. In the study group, the median follow-up from completion of the RTX and IVIg treatment protocol was 11 months. No adverse events, immediate or delayed, were reported in any of the patients who received the combination therapy of RTX and IVIg.
In this preliminary study, the combination therapy of RTX and IVIg arrested disease progression and prevented total blindness in patients with recalcitrant OCP.
比较利妥昔单抗（RTX）联合静脉注射免疫球蛋白（IVIg）与其他免疫抑制方案治疗眼瘢痕性类天疱疮（OCP）的疗效和安全性。
回顾性、比较性、干预性病例系列研究。
12 例 OCP 患者。
我们回顾了 12 例 OCP 患者的病历。12 例患者中有 10 例在初始系统性免疫抑制治疗后（第 1 阶段治疗），1 只眼失明。然后，根据第 2 阶段接受的治疗将患者分为 2 组。研究组由 6 例在治疗第 2 阶段接受 RTX 和 IVIg 联合治疗的患者组成。为了比较目的，对照组由 6 例在治疗第 2 阶段接受更积极的免疫抑制治疗但未接受 RTX 和 IVIg 的患者组成，因为保险公司拒绝支付联合治疗费用。
失明（最佳矫正视力[BCVA]≤20/200）和 OCP 分期（福斯特）。
对照组和研究组的中位总随访期分别为 57.5 个月和 55.5 个月。第 1 阶段治疗后，对照组 6 例患者均 1 只眼失明。同样，研究组 4 例患者 1 只眼失明，而 2 例患者双眼 BCVA 良好，但尽管第 1 阶段治疗后仍持续存在结膜炎症。第 2 阶段治疗后，对照组 6 例患者 OCP 均进展，双眼失明。相比之下，研究组 6 例患者的 BCVA 稳定，OCP 分期无进一步进展。在研究组中，从完成 RTX 和 IVIg 治疗方案到中位随访时间为 11 个月。接受 RTX 和 IVIg 联合治疗的患者均未报告任何即时或迟发性不良事件。
在这项初步研究中，RTX 联合 IVIg 治疗可阻止难治性 OCP 患者的疾病进展并防止其完全失明。
