The efficacy of tacrolimus in patients with interstitial lung diseases complicated with polymyositis or dermatomyositis.
OBJECTIVE
Interstitial lung diseases (ILDs) complicated with PM or DM are frequently aggressive and refractory to treatment. Recently some reports have suggested the potential benefit of tacrolimus for severe ILD complicated with PM/DM. However, little evidence has yet shown the efficacy of tacrolimus in these settings. The aim of this study was to evaluate the efficacy of tacrolimus as a treatment for PM-/DM-related ILD.


METHODS
This retrospective study comprised 49 previously untreated patients diagnosed as PM-/DM-related ILD admitted to Hokkaido University Hospital from January 2000 to July 2013. These patients were treated with tacrolimus plus conventional therapy or only with conventional therapy (prednisolone, i.v. CYC and/or ciclosporin). The primary endpoint was defined as the time to relapse or death of respiratory cause or a serious adverse event. The secondary endpoint was defined as the time from the initiation of immunosuppressive treatment to relapse or death of respiratory cause. Endpoints were compared by adjusted Cox regression model by using inverse probability of treatment weighting in order to reduce the impact of these selection biases and potential confounding factors.


RESULTS
After adjustment, the tacrolimus group (n = 25) had significantly longer event-free survival as compared with the conventional therapy group (n = 24). The weighted hazard ratio (HR) was 0.32 (95% CI 0.14, 0.75, P = 0.008). In addition, the tacrolimus group had significantly longer disease-free survival as compared with the conventional therapy group. The weighted HR was 0.25 (95% CI 0.10, 0.66, P = 0.005).


CONCLUSIONS
The addition of tacrolimus to conventional therapy significantly improved the prognosis of patients with PM-/DM-related ILD.
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Takashi
T
Kurita
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan. syasuda@med.hokudai.ac.jp.
Shinsuke
S
Yasuda
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Koji
K
Oba
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Toshio
T
Odani
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Michihito
M
Kono
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Kotaro
K
Otomo
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Yuichiro
Y
Fujieda
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Kenji
K
Oku
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Toshiyuki
T
Bohgaki
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Olga
O
Amengual
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Tetsuya
T
Horita
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Tatsuya
T
Atsumi
D000328:Adult; D000368:Aged; D003882:Dermatomyositis / Q000150:complications*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007564:Japan; D017563:Lung Diseases, Interstitial / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017285:Polymyositis / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016559:Tacrolimus
dermatomyositis; interstitial; lung diseases; polymyositis; tacrolimus