Early clinical experiences with mycophenolate mofetil for immunosuppressive therapy of ocular cicatrical pemphigoid

Background: Ocular cicatrical pemphigoid can lead to severe structural dama ge or loss of vision at worst. Longterm therapy with dapsone or systemic im munosuppressive therapy, e.g. with cyclophosphamide is often inevitable. Im munosuppression may cause severe side effects in some patients. Patients and methods: Data are presented on 5 patients with ocular cicatric al pemphigoid who were treated with mycophenolate mofetil 2 g daily. Criter ion of effectiveness was the clinical course of the condition defined as no nprogression of the morphologic alterations. Patients were initially examin ed and interviewed routinely every four weeks for the first four months, th en every eight weeks. Patients were asked about side effects and underwent monthly blood checks. Results: All patients were followed for at least 12 months. Mycophenolate m ofetil proved to be effective with respect to the clinical course in 9 out of 10 eyes. All patients showed regression of inflammatory conjunctival alt eration and improvement of their complaints. In one eye the inflammatory pr ocess restarted after surgery due to excessive symblephara had been perform ed. Gastrointestinal side effects were reported in the initial phase, e.g. lack of appetite, nausea and mild diarrhoea. Conclusions: Mycophenolate mofetil proved to be an effective immunosuppress ant for the treatment of ocular cicatrical pemphigoid. Namely side effects were less severe and frequent compared to those known from other currently administered immunosuppressants. Longterm results and larger case numbers a re needed to sustain these early results.