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(IRB Number: Pro00095121) , Tecnologico de Monterrey (Ethics License No.: P000561-PC-RV-OMMP-CEIC-CR002, Research License No.: P000561-PC-RV-OMMP-CI-CR002) , and Hospital Clinic of Barcelona (IRB Number: CEIm HCB/2019/0712) previously revised and approved the study. All research adhered to the tenets of the Declaration of Helsinki. The IRBs of the three institutions approved this study with a waiver of informed consent due to the retrospective nature of the study.

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Ocular Mucous Membrane Pemphigoid: The Effect of Risk Factors at Presentation on Treatment Outcomes

Publicated to:Ophthalmology. 131 (9): 1064-1075 - 2024-09-01 131(9), DOI: 10.1016/j.ophtha.2024.02.028

Authors: Ruiz-Lozano, RE; Quiroga-Garza, ME; Azar, NS; Mousa, HM; Perez, VL; Colorado-Zavala, MF; Ramos-Davila, EM; Hernandez-Camarena, JC; Rodriguez-Garcia, A; Stinnett, SS; Daluvoy, M; Kim, T; Sainz-de-la-Maza, M; Hall, RP

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Abstract

Purpose: Analyze the influence of risk factors at presentation in the long-term immunosuppressive therapy (IMT) outcomes of ocular mucous membrane pemphigoid (OMMP). Design: Retrospective multicenter study. Participants: Patients with OMMP seen at the Duke Eye Center, Tecnologico de Monterrey, and Hospital Clinic of Barcelona from 1990 to 2022. Methods: Data at presentation on demographics, direct immunofluorescence, ocular findings, sites of extraocular manifestations (EOMs), and previous treatments in patients with a clinical or laboratory diagnosis of OMMP, were analyzed with multivariable analysis and Kaplan-Meier plots to identify factors associated with adverse outcomes. Main Outcome Measures: (1) Inflammatory control (no conjunctival inflammation in both eyes at 3 months on IMT); (2) relapse (new-onset inflammation after absolute control in either eye); (3) progression (>= 1 cicatrizing stage progression in either eye); and (4) vision loss (>= 2 Snellen lines). Results: A total of 117 patients (234 eyes), 61% (71/117) of whom were women, with a mean age of 66.6 (SD: 12.4) years (range: 37-97 years) and median follow-up of 34 months (interquartile range: 16-66 months; range: 3-265 months), were enrolled. Inflammatory control was achieved in 57% of patients (67/117), with high-risk EOM (HR-EOM), including esophageal, nasopharyngeal, and/or genital involvement (adjusted odds ratio [aOR]: 12.51; 95% confidence interval [CI]: 2.61-59.99; P = 0.002) and corneal scarring (aOR: 3.06; 95% CI, 1.15-8.14; P = 0.025), as significant risk factors for persistent inflammation. Disease relapse, progression, and vision loss occurred in 20% of patients (23/117), 12% of patients (14/117), and 27% of patients (32/117), respectively. Baseline corneal scarring was a risk factor for relapse (adjusted hazard ratio: 4.14; 95% CI: 1.61-10.62; P = 0.003), progression (aOR: 11.46; 95% CI: 1.78-73.75; P = 0.010), and vision loss (aOR: 3.51; 95% CI: 1.35-9.10; P = 0.010). HR-EOM was associated with stage progression (aOR, 34.57; 95% CI, 6.57-181.89; P

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