title: Developing standardised treatment for adults with myositis and different phenotypes: an international survey of current prescribing preferences.
abstract: OBJECTIVE
  The evidence base for treatment of the idiopathic inflammatory myopathies is extremely limited. The rarity and heterogeneity of these diseases has hampered the development of good quality clinical trials and while a range of immunomodulatory treatments are commonly used in clinical practice, as yet there are no clear guidelines directing their use. We aimed to establish current prescribing regimens used to treat adults with myositis internationally.
  
  
  METHODS
  An electronic survey based on different clinical scenarios was distributed internationally to clinicians involved in the treatment of patients with myositis. Participants were asked to select their first-line treatment preferences in each situation. A multinomial regression analysis was used to assess the influence of clinical scenario, respondent expertise and country of origin on first-line treatment choice.
  
  
  RESULTS
  107 survey responses were received. 57% of respondents considered themselves an expert in myositis and the majority of respondents were rheumatologists although responses from other specialities were also received. Pharmacological treatment with steroids and additional immunotherapy was the preference in most scenarios. First-line immunosuppressant choice was significantly influenced by the clinical scenario, the expertise of the treating physician and country of practice. Azathioprine, methotrexate and mycophenolate mofetil were the most commonly chosen agents.
  
  
  CONCLUSIONS
  In the absence of available evidence, clinical experience and expert consensus often forms the basis of treatment guidelines. These results suggest that an international consensus approach would be possible in myositis and would overcome an urgent, yet unmet need for patients suffering with this difficult disease.
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Foundation Trust, Bath; and University of Bath, UK. s.tansley@nhs.net.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tansley
authors.affiliation: University of Bath, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: Shaddick
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Christopher-Stine
authors.affiliation: Salford Royal NHS Foundation Trust, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sharp
authors.affiliation: Department of Dermatology and Venereology, Medical University of Sofia, Bulgaria.
authors.forename: Lyubomir
authors.initials: L
authors.lastname: Dourmishev
authors.affiliation: Department of Rheumatology, University Hospital Zurich, Switzerland.
authors.forename: Britta
authors.initials: B
authors.lastname: Maurer
authors.affiliation: Salford Royal NHS Foundation Trust; and National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, University of Manchester, UK.
authors.forename: Hector
authors.initials: H
authors.lastname: Chinoy
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Foundation Trust, Bath; and University of Bath, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: McHugh
mesh_terms: D001291:Attitude of Health Personnel; D032921:Consensus; D011307:Drug Prescriptions; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009220:Myositis / Q000175:diagnosis / Q000188:drug therapy*; D010641:Phenotype; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D000072140:Rheumatologists / Q000523:psychology / Q000592:standards / Q000639:trends*; D012219:Rheumatology / Q000592:standards / Q000639:trends*
chemical_list: D007166:Immunosuppressive Agents