title: Intravenous immunoglobulin as add on treatment with mycophenolate mofetil in severe myositis.
abstract: OBJECTIVE
  To report the use of intravenous immunoglobulin (IVIg) and mycophenolate mofetil (MMF) in polymyositis (PM) and dermatomyositis (DM).
  
  
  METHODS
  We performed an open study in PM and DM with active disease. Indications for treatment were: steroid-dependency, refractoriness to steroid and/or immunosuppressants, and life-threatening disease. IVIg was used at 2 g/kg in monthly cycles for six months and then each other month for other three cycles. MMF was slowly titrated to 30 mg/kg/day orally. Parameters employed to follow patients were the Medical Research Council (MRC) scale, the modified Rankin score, CK serum levels and daily prednisone dose.
  
  
  RESULTS
  Seven patients were studied (4PM, 3DM). All were females, with a mean age of 49 years. All of them achieved a complete remission and, at the last follow-up visit, significant differences in MRC score, modified Rankin score, CK levels, and the daily maintenance prednisone dose were documented. No relevant side effects were observed.
  
  
  CONCLUSIONS
  IVIg as add on treatment with MMF is effective in severe and refractory myositis, moreover as safe and steroid-sparing agent.
authors.affiliation: Clinica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Torrette di Ancona, Italy. mgdanieli@mail.com
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Danieli
authors.forename: Lucia
authors.initials: L
authors.lastname: Calcabrini
authors.forename: Vincenzina
authors.initials: V
authors.lastname: Calabrese
authors.forename: Annalisa
authors.initials: A
authors.lastname: Marchetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Logullo
authors.forename: Armando
authors.initials: A
authors.lastname: Gabrielli
mesh_terms: D000368:Aged; D003402:Creatine Kinase / Q000097:blood; D003680:Deglutition Disorders; D003882:Dermatomyositis / Q000097:blood / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D018450:Disease Progression; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004417:Dyspnea; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D017285:Polymyositis / Q000097:blood / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D012074:Remission Induction
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D003402:Creatine Kinase; D009173:Mycophenolic Acid