Targeted immunotherapy trials for idiopathic inflammatory myopathies.

The idiopathic inflammatory myopathies (IIM) are a group of muscle diseases with complex immunopathogenesis that varies between disease subgroups, and possibly between patients within the same subgroup. There exists no universal consensus on optimum management, so that no "standard" therapy has been developed. Treatment-refractive IIM remains a clinical challenge. Progress in the development and application of molecular biology techniques and biological therapeutics are evolving into a new scientific frontier in the management of autoimmune diseases. This review offers an update on those components of the humoral and cellular immunity deemed potential targets for biological therapeutics (monoclonal antibodies and fusion proteins) that have been approved by the US FDA for treatment of immunological disorders. A futuristic approach is envisioned in which each individual will receive targeted therapy tailored to patient-specific immune mechanisms. Risk-benefit and cost analyses should determine whether such targeted therapy is appropriate and feasible for refractive and/or newly diagnosed disease.