Chlorambucil. An effective corticosteroid-sparing agent for patients with recalcitrant dermatomyositis.
OBJECTIVE
To investigate the effectiveness of oral chlorambucil treatment in patients with dermatomyositis (DM) that is recalcitrant to treatment with prednisone and/or immunosuppressive agents.


METHODS
Five patients with recalcitrant DM were treated with oral chlorambucil, 4 mg/day, after discontinuation of the other immunosuppressive agent (azathioprine or methotrexate). Three patients were treated with a combination of prednisone and chlorambucil, and 2 with chlorambucil alone.


RESULTS
Beneficial effects were noted within 4-6 weeks in all 5 patients, and corticosteroids were eventually discontinued in 4. Currently, only 1 patient is still receiving therapy; the other 4 have stopped chlorambucil after 13-30 months of treatment, and their disease remains in remission. Minimal chlorambucil toxicity was noted, consisting of leukopenia in 2 patients.


CONCLUSIONS
Our findings suggest that chlorambucil is an effective, corticosteroid-sparing agent for the control of DM.
Sinoway
P A
PA
Division of Dermatology, University of Louisville, Kentucky 40202.
Callen
J P
JP
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002699:Chlorambucil / Q000627:therapeutic use*; D003402:Creatine Kinase / Q000097:blood; D003882:Dermatomyositis / Q000097:blood / Q000188:drug therapy*; D004351:Drug Resistance; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D002699:Chlorambucil; D003402:Creatine Kinase; D011241:Prednisone