Qualifying criteria have been expanded to Moderate to severe disease diagnosed by a Qualifying Criteria Moderate to severe CP/MMP disease require diagnostic confirmation and appropriate dermatologist; proven by biopsy and serology with disease required for to severe ‘moderate involvement of multiple sites, oesophageal disease’. (A) AND involvement alone or conjunctiva alone. Criteria are consistent with original version with AND details defined. (A) Corticosteroids or immunosuppressive E.g. immunosuppressant therapeutics that need agents are contraindicated; Persistent disease despite standard to have been tried include: corticosteroid and treatment with at least 2 Corticosteroids OR immunosuppressant agents or B cell Azathioprine depletion therapy (Rituximab) Cyclophosphamide Condition is unresponsive to Methotrexate OR Mycophenolate corticosteroids and immunosuppressive Rituximab agents; Severe side effects prohibit the continuation of corticosteroids and immunosuppressive Severe side effects of immunosuppressant OR agents unless corticosteroids or therapy include: immunosuppressant agents are Significant infection including sepsis Presenting with severe side effects of contraindicated. Malignancy Marrow suppression and cytopenia therapy. Unstable Diabetes Severe osteoporosis History of avascular necrosis Initial review to confirm response is unchanged, Response demonstrated at review at six Review Criteria Review is required every six months by a however, ongoing six monthly review has been months. Improvement to be dermatologist or clinical immunologist. added with specific criteria defined for ongoing demonstrated for continuation of Response must be demonstrated at the initial treatment. (A) review at six months and improvement must supply. Consideration is now to trial off therapy once be demonstrated for continuation of supply. disease is stable and/or reduce Ig dose. Disease recurrence or relapse and Consideration should be given to a trial-off duration of clinical remission. immunoglobulin (Ig) therapy once the patient has achieved stabilised disease or clinical
Qualifying Criteria Moderate to severe disease diagnosed by a dermatologist; AND Corticosteroids or immunosuppressive agents are contraindicated; OR Condition is unresponsive to corticosteroids and immunosuppressive agents; OR Presenting with severe side effects of therapy. Moderate to severe CP/MMP disease proven by biopsy and serology with involvement of multiple sites, oesophageal involvement alone or conjunctiva alone. AND Persistent disease despite standard corticosteroid and treatment with at least 2 immunosuppressant agents or B cell depletion therapy (Rituximab) OR Severe side effects prohibit the continuation of corticosteroids and immunosuppressive agents unless corticosteroids or immunosuppressant agents are contraindicated. Qualifying criteria have been expanded to require diagnostic confirmation and appropriate disease required for ‘moderate to severe disease’. (A) Criteria are consistent with original version with details defined. (A) E.g. immunosuppressant therapeutics that need to have been tried include: Corticosteroids Azathioprine Cyclophosphamide Methotrexate Mycophenolate Rituximab Severe side effects of immunosuppressant therapy include: Significant infection including sepsis Malignancy Marrow suppression and cytopenia Unstable Diabetes Severe osteoporosis History of avascular necrosis Review Criteria Response demonstrated at review at six months. Improvement to be demonstrated for continuation of supply. Disease recurrence or relapse and duration of clinical remission. Review is required every six months by a dermatologist or clinical immunologist. Response must be demonstrated at the initial review at six months and improvement must be demonstrated for continuation of supply. Consideration should be given to a trial-off immunoglobulin (Ig) therapy once the patient has achieved stabilised disease or clinical Initial review to confirm response is unchanged, however, ongoing six monthly review has been added with specific criteria defined for ongoing treatment. (A) Consideration is now to trial off therapy once disease is stable and/or reduce Ig dose.
cicatricial-pemphigoid-cp-or-mucous-membrane-pemphigoid-mmp.DOCX