title: Combination with corticosteroids and cyclosporin-A improves pulmonary function test results and chest HRCT findings in dermatomyositis patients with acute/subacute interstitial pneumonia.
abstract: We retrospectively examined the effect of combination therapy with prednisolone and cyclosporin-A (CSA) on the findings of pulmonary function tests (PFTs) and chest high-resolution computed tomography (HRCTs) scans in patients with dermatomyositis (DM) and acute/subacute interstitial pneumonia (A/SIP). We also examined whether CSA therapy improved PFT and chest HRCT findings. DM patients (n=14) with A/SIP were treated with 1 mg/kg/day prednisolone and 4 mg/kg/day CSA within 4.4 days (range, 1-12 days) from diagnosis. The trough level (C0) and 2-h post-dose blood concentration (C2) of CSA were measured. PFTs and HRCT scans were performed before and 1 year after treatment. The total ground-glass opacity area was calculated with the HRCT findings and used as the CT score. Combination prednisolone and CSA therapy improved the TLC%, VC%, FVC%, EFV1.0%, and CT score (P=0.027, 0.003, 0.002, 0.001, and 0.001, respectively). The C0 level was 178.8 ng/ml (range, 71-456 ng/ml), and the C2 level was 1,336.6 ng/ml (range, 814-2,873 ng/ml). Therapeutic changes in FVC%, FEV1.0%, and DLCO% were correlated with the C2 CSA level (P=0.047, 0.025, and 0.035, respectively). However, the PFT results and CT scan scores did not correlate with the daily dose or C0 level of CSA. Improvements in the CT score were correlated with time from IP diagnosis to CSA initiation (P=0.014). Early intervention with prednisolone and CSA combination therapy and tight control of the daily CSA dose by monitoring the C2 level improved PFT and chest HRCT findings in DM-A/SIP.
authors.affiliation: First Department of Internal Medicine, Osaka Medical College, Daigaku-Machi 2-7, Takatsuki, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Kotani
authors.forename: Tohru
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Makino
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Hata
authors.forename: Shuzo
authors.initials: S
authors.lastname: Yoshida
authors.forename: Koji
authors.initials: K
authors.lastname: Nagai
authors.forename: Daisuke
authors.initials: D
authors.lastname: Wakura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shoda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hanafusa
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003882:Dermatomyositis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone