Intravenous immunoglobulin as add on treatment with mycophenolate mofetil in severe myositis.
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.
Danieli
Maria Giovanna
MG
Clinica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Torrette di Ancona, Italy. mgdanieli@mail.com
Calcabrini
Lucia
L
Calabrese
Vincenzina
V
Marchetti
Annalisa
A
Logullo
Francesco
F
Gabrielli
Armando
A
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
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D003402:Creatine Kinase; D009173:Mycophenolic Acid