G Keyßer1, S Zierz2, M Kornhuber3. 1. Department of Internal Medicine, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany. gernot.keyszer@uk-halle.de. 2. Clinic for Neurology, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany. 3. HELIOS Klinik Sangerhausen, Am Beinschuh 2a, 06526, Sangerhausen, Germany.
Abstract
OBJECTIVES: To gain information about the efficacy of immunosuppressive drugs as first-, second-, and third-line treatment of idiopathic inflammatory myopathies (IIM). METHODS: 112 treatment cycles of 63 patients with dermatomyositis (n = 23), polymyositis (n = 33), overlap syndromes (n = 4), and undifferentiated connective tissue diseases (n = 3) were analyzed by retrospective chart analysis. Data regarding muscle strength, muscle enzymes, treatment duration, and treatment discontinuation were collected. RESULTS: Azathioprine (38 cycles) and methotrexate (MTX; 24 cycles) were applied significantly longer than glucocorticoid monotherapy (9 cycles; 25 ± 21, 26 ± 29 and 7 ± 4 months, respectively; p < 0.05). MTX and azathioprine achieved a significant reduction of serum creatine kinase (CK), with MTX showing more marked effects. Treatment cycles with immunosuppressants other than MTX or azathioprine (n = 22) or with combinations of immunosuppressive drugs (n = 19) were mostly applied as third-line therapy, indicating their application in more refractory cases. Significant improvement of muscle strength was confined to MTX and azathioprine and to the first-line treatment. 8% of MTX patients withdrew due to the lack of efficacy, compared with 29% of patients taking azathioprine and 6 of 9 patients taking glucocorticoid monotherapy. In the 12 patients with Jo-1 syndrome, MTX treatment was effective for a longer time than azathioprine (44 ± 21 months vs. 27 ± 24 months, p < 0.05). CONCLUSION: Our data confirm the effectiveness of MTX and azathioprine in the treatment of inflammatory myopathies and stress the importance of a potent first-line therapy.
OBJECTIVES: To gain information about the efficacy of immunosuppressive drugs as first-, second-, and third-line treatment of idiopathic inflammatory myopathies (IIM). METHODS: 112 treatment cycles of 63 patients with dermatomyositis (n = 23), polymyositis (n = 33), overlap syndromes (n = 4), and undifferentiated connective tissue diseases (n = 3) were analyzed by retrospective chart analysis. Data regarding muscle strength, muscle enzymes, treatment duration, and treatment discontinuation were collected. RESULTS:Azathioprine (38 cycles) and methotrexate (MTX; 24 cycles) were applied significantly longer than glucocorticoid monotherapy (9 cycles; 25 ± 21, 26 ± 29 and 7 ± 4 months, respectively; p < 0.05). MTX and azathioprine achieved a significant reduction of serum creatine kinase (CK), with MTX showing more marked effects. Treatment cycles with immunosuppressants other than MTX or azathioprine (n = 22) or with combinations of immunosuppressive drugs (n = 19) were mostly applied as third-line therapy, indicating their application in more refractory cases. Significant improvement of muscle strength was confined to MTX and azathioprine and to the first-line treatment. 8% of MTXpatients withdrew due to the lack of efficacy, compared with 29% of patients taking azathioprine and 6 of 9 patients taking glucocorticoid monotherapy. In the 12 patients with Jo-1 syndrome, MTX treatment was effective for a longer time than azathioprine (44 ± 21 months vs. 27 ± 24 months, p < 0.05). CONCLUSION: Our data confirm the effectiveness of MTX and azathioprine in the treatment of inflammatory myopathies and stress the importance of a potent first-line therapy.
Authors: Alexander G S Oldroyd; James B Lilleker; Tania Amin; Octavio Aragon; Katie Bechman; Verna Cuthbert; James Galloway; Patrick Gordon; William J Gregory; Harsha Gunawardena; Michael G Hanna; David Isenberg; John Jackman; Patrick D W Kiely; Polly Livermore; Pedro M Machado; Sue Maillard; Neil McHugh; Ruth Murphy; Clarissa Pilkington; Athiveeraramapandian Prabu; Phoebe Rushe; Stefan Spinty; Joanne Swan; Hasan Tahir; Sarah L Tansley; Paul Truepenny; Yvonne Truepenny; Kishore Warrier; Mark Yates; Charalampia Papadopoulou; Neil Martin; Liza McCann; Hector Chinoy Journal: Rheumatology (Oxford) Date: 2022-05-05 Impact factor: 7.046