[Treatment of steroid-resistant polymyositis and dermatomyositis].
It is well known that a certain percentage of patients with polymyositis and dermatomyositis (PM/DM) is corticosteroid resistant. Established and novel approaches to steroid-resistant PM/DM are discussed in this review. Methotrexate (MTX) is a first-line treatment in the case that steroid therapy fails. Azathioprine and cyclophosphamide also fall into this category. Cyclosporine, a specific inhibitor of calcineurin, has been reported almost as effective as MTX. Tacrolimus, also a calcineurin inhibitor, and mycophenolate mofetil could be additional alternatives for the treatment. Several clinical trials have demonstrated that high-dose intravenous immunoglobulin is promising. Recently favorable data have been published using intravenous high-dose pulse cyclophosphamide or cyclosporine for the poorly prognostic interstitial pneumonitis or pulmonary fibrosis accompanied with PM/DM.
Mimura
T
T
Departments of Allergy/Rheumatology and Nephrology/Endocrinology, University of Tokyo.
Kanda
H
H
Kubo
K
K
D000818:Animals; D000893:Anti-Inflammatory Agents; D001379:Azathioprine / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage; D003882:Dermatomyositis / Q000150:complications / Q000628:therapy*; D004351:Drug Resistance; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D017563:Lung Diseases, Interstitial / Q000209:etiology / Q000628:therapy; D008727:Methotrexate / Q000008:administration & dosage; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017285:Polymyositis / Q000150:complications / Q000628:therapy*; D013256:Steroids; D016559:Tacrolimus / Q000008:administration & dosage
D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus; D008727:Methotrexate