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Treatment of Mucous Membrane Pemphigoid With Mycophenolate Mofetil

Nottage, Jennifer M. MD; Hammersmith, Kristin M. MD; Murchison, Ann P. MD, MPH; Felipe, Anthony F. MD; Penne, Robert MD; Raber, Irving MD

doi: 10.1097/ICO.0b013e31826af7b8
Clinical Science

Purpose: To evaluate the clinical outcomes of mycophenolate mofetil (MMF) treatment of mucous membrane pemphigoid (MMP).

Methods: This is a retrospective analysis of consecutive patients with clinical MMP seen in the Ocular Surface Disease Clinic at the Wills Eye Institute, between January 1, 2004, and December 31, 2010, treated with MMF. The main outcomes measured were control of inflammation and discontinuation of MMF.

Results: A total of 23 MMP patients taking MMF were identified. The median age of the MMF-treated patients was 77.0 years. Eleven of the 23 patients (47.8%) had biopsy-proven MMP. All patients were at least Foster grading system stage 2, with most stage 3 or 4. Eight patients (34.8%) failed previous treatments with dapsone, methotrexate, prednisone, azathioprine, cyclophosphamide, or 6-mercaptopurine. The average duration of MMF treatment was 23.32 ± 33.17 months (range 1–124.83 months, median 7.4 months). Of the 23 patients with MMP, control of inflammation was achieved with MMF within 3 months for 56.5% [95% confidence interval (CI) 54.5–59.6], within 6 months for 69.6% (95% CI 65.2–76.6), and within 12 months for 82.6% (95% CI 75.3–92.4) of the patients. Nineteen patients (82.4%) achieved control of inflammation, with 16 of the 19 (84.2%) achieving control of inflammation with MMF as monotherapy. Fifteen patients were treated with MMF as initial therapy. Twenty-one percent of patients (5 of 23) were taken off MMF for failure of inflammatory control (4) or an allergic reaction (1).

Conclusions: Treatment of MMP with MMF in this uncontrolled case series resulted in control of inflammation in the majority of patients with minimal side effects. Our data support consideration of MMF as an initial treatment option for active ocular MMP.

*Department of Ophthalmology, Cornea Service, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA

Eye Consultants of Maryland, Owings Mills, MD

Department of Ophthalmology, Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.

Reprints: Kristin M. Hammersmith, Cornea Service, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, 840 Walnut St, Suite 920, Philadelphia, PA 19107 (e-mail: khammersmith@willseye.org).

Presented as a poster at the Association for Research in Vision and Ophthalmology Annual Meeting, May 2011.

The authors have no funding or conflicts of interest to disclose.

Received March 23, 2012

Accepted July 20, 2012

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