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Pharmacologic Agents in the Treatment of DM

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Dermatomyositis
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The cornerstone of therapy is immunosuppressive medication. Corticosteroids, immuno-suppressive agents, high-dose intravenous immunoglobulin (IVIG), and antimalarial drugs are the principal medicines with marked efficacy in the treatment of DM [1–3]. Truly refractory patients may benefit from pulse corticosteroids, followed by tapering of oral prednisone, intravenous immunoglobulin, or cyclosporine A [4].

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References

  1. Raifman CM, Schaffer FM, Wachsmuth SE. Reversal of chronic polymyositis following intravenous immune serum globin therapy. JAMA 1987; 258: 513–515.

    Google Scholar 

  2. Gelfand E W. The use of intravenous immune globulin in collagen vascular disorders: a potentially new modality of therapy. J Allergy Clin Immunol 1989; 84(4 Pt 2): 613–615.

    Article  PubMed  CAS  Google Scholar 

  3. Dalakas MC, Illa I, Dambrosia JM, et al. A controlled trial of high-dose intravenous immu-noglobulin infusions as treatment for dermatomyositis. N Engl J Med 1993; 329: 1993–2000.

    Article  PubMed  CAS  Google Scholar 

  4. Cherin P, Herson S, Wechsler B, et al. Efficacy of intravenous gammaglobulin therapy in chronic refractory polymyositis and dermatomyositis: an open study with 20 adult patients. Am J Med 1991; 91: 162–168.

    Article  PubMed  CAS  Google Scholar 

  5. Lang BA, Laxer RM, Murphy G, et al. Treatment of dermatomyositis with intravenous gam-maglobulin. Am J Med 1991; 91: 169–172.

    Article  PubMed  CAS  Google Scholar 

  6. Dalakas MC. Intravenous immunoglobulin for dermatomyositis. N Engl J Med 1994; 330: 1392–1393.

    Article  Google Scholar 

  7. Patel SY, Kumararatne DS. From black magic to science: understanding the rationale for the use of intravenous immunoglobulin to treat inflammatory myopathies. Clin Exp Immunol 2001; 124: 169–171.

    Article  PubMed  CAS  Google Scholar 

  8. Basta M, Dalakas MC. High-dose intravenous immunoglobulin exerts its beneficial effect in patients with dermatomyositis by blocking endomysial deposition of activated complement fragments. J Clin Invest 1994; 94: 1729–1735.

    Article  PubMed  CAS  Google Scholar 

  9. Amemiya K, Semino-Mora C, Granger R P, et al. Downregulation of TGF-β1 mRNA and protein in the muscles of patients with inflammatory myopathies after treatment with high-dose intravenous immunoglobulin. Clin Immunol 2000; 94: 99–104.

    Article  PubMed  CAS  Google Scholar 

  10. Yu Z, Lennon VA. Mechanism of intravenous human globin therapy in antibody-mediated autoimmune disease. N Engl J Med 1999; 340: 227–228.

    Article  PubMed  CAS  Google Scholar 

  11. Lutz HU, Stammler P, Jelezarova E, et al. High doses of immunoglobulin G attenuate immune aggregate-mediated complement activation by enhancing physiologic cleavage of C3b in C3bn-IgG complexes. Blood 1996; 88: 184–193.

    PubMed  CAS  Google Scholar 

  12. Kazatchkine MD, Kaveri S V. Immunomodulation of autoimmune and inflammatory disease with intravenous immunoglobulin. N Engl J Med 2001; 345: 747–755.

    Article  PubMed  CAS  Google Scholar 

  13. Götterfied I, Seeber A, Anegg B, et al. High dose intravenous immunoglobulin (IVIG) in der-matomyositis: clinical responses and effect on sIL-2R levels. Eur J Dermatol 2000; 10: 29–35.

    Google Scholar 

  14. Sansome A, Dubowitz V. Intravenous immunoglobulin in juvenile dermatomyositis—four year review of nine cases. Arch Dis Child 1995; 72(1): 25–28.

    Article  PubMed  CAS  Google Scholar 

  15. Morita R, Nakano K, Hirano Y, et al. Dramatic effects of high-dose intravenous gammaglobu-lin in each patient with intractable dermatomyositis and polymyositis. No To Hattatsu 1989; 21(6): 523–528 [Japanese].

    PubMed  CAS  Google Scholar 

  16. Sadayama T, Miyagawa S, Shirai T. Low-dose intravenous immunoglobulin therapy for intactable dermatomyositis skin lesions. J Dermatol 1999; 26: 457–459.

    PubMed  CAS  Google Scholar 

  17. Saadeh C, Bridges W, Burwick F. Dermatomyositis: remission induced with combined oral cyclosporine and high-dose intravenous immune globulin. South Med J 1995; 88(8): 866–870.

    PubMed  CAS  Google Scholar 

  18. Mastaglia FL, Phillips BA, Zilko PJ. Immunoglobulin therapy in inflammatory myopathies. J Neurol Neurosurg Psychiatry 1998; 65: 107–110.

    Article  PubMed  CAS  Google Scholar 

  19. Cherin P, Pelletier S, Teixeira A, et al. Results and long-term follow-up of intravenous immu-noglobulin infusions in chronic refractory polymyositis: an open study with 35 adult patients. Arthritis Rheum 2002; 46(2): 467–474.

    Article  PubMed  CAS  Google Scholar 

  20. Dalakas MC. High-dose intravenous immunoglobulin in inflammatory myopathies: experience based on controlled clinical trials. Neurol Sci 2003; 24: S256–S259.

    Article  PubMed  Google Scholar 

  21. Dalakas MC. Intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: present status and practical therapeutic guidelines. Muscle Nerve 1999; 22: 1479–1497.

    Article  PubMed  CAS  Google Scholar 

  22. Danieli MG, Malcangi G, Palmieri C, et al. Cyclosporin A and intravenous immunoglobulin treatment in polymyositis/dermatomyositis. Ann Rheum Dis 2002; 61: 37–41.

    Article  PubMed  CAS  Google Scholar 

  23. Eshraghi N, Farahmand M, Maerz LL, et al. Adult-onset dermatomyositis, with severe gastrointestinal manifestations: case report and review of the literature. Surgery 1998; 123: 356–358.

    PubMed  CAS  Google Scholar 

  24. Rigby S P, Schott JM, Bliss P, et al. Dilated stomach and weak muscles. Lancet 2000; 356: 1898.

    Article  PubMed  CAS  Google Scholar 

  25. Marie I, Levesque H, Cailleux N, et al. Intravenous immunoglobulin for treatment of gastrointestinal haemorrhage in dermatomyositis. Ann Rheum Dis 2001; 60: 723–724.

    Article  PubMed  CAS  Google Scholar 

  26. Fukunaga E, Kunishigea M, Mitsuia T, et al. Severe dermatomyositis with rhabdomyolysis and paralytic ileus: a case successfully treated with plasmapheresis and intravenous immu-noglobulin. EFNS Eur J Neurol 2002; 9: 687–702.

    Google Scholar 

  27. Ratko TA, Burnett DA, Foulke GE, et al. Recommendations for off-label use of intravenously administered immunoglobulin preparations. JAMA 1995; 273: 457–492.

    Article  Google Scholar 

  28. Jolles S, Hughes J, Whittacker S. Dermatological uses of high-dose intravenous immuno-globulin. Arch Dermatol 1998; 134: 80–86.

    Article  PubMed  CAS  Google Scholar 

  29. Roujeau JC. Dermatomyositis. In: Therapeutique Dermatologique, Dubertret L (ed.), Medecine-Sciences, Flammarion, Paris, 2001; 178–182.

    Google Scholar 

  30. Hengstman GJ, van den Hoogen FH, Barrera P, et al. Successful treatment of dermatomyositis and polymyositis with anti-tumor-necrosis-factor-alpha: preliminary observations. Eur Neu-rol 2003; 50: 10–15.

    CAS  Google Scholar 

  31. Maillard SM, Wilkinson N, Davidson JE, Murray KJ. The treatment of persistent severe idiopathic inflammatory myositis with anti TNF therapy. Ann Rheum Dis 2002; 61: S143.

    Google Scholar 

  32. Mastaglia FL, Garlepp MJ, Phillips BA, et al. Inflammatory myopathies: clinical, diagnostic and therapeutic aspects. Muscle Nerve 2003; 27(4): 407–425.

    Article  PubMed  Google Scholar 

  33. Hengstman G, van den Hoogen F, van Engelen B, et al. Anti-TNF-α blockade with infliximab (Remicade) in polymyositis and dermatomyositis [abstract]. Arthritis Rheum 2000; 43: S193.

    Google Scholar 

  34. Musial J, Undas A, Celinska-Lowenhoff M. Polymyositis associated with infliximab treatment for rheumatoid arthritis. Rheumatology 2003; 42: 1566–1568.

    Article  PubMed  CAS  Google Scholar 

  35. Riley P, McCann LJ, Maillard SM, et al. Effectiveness of infliximab in the treatment of refractory juvenile dermatomyositis with calcinosis. Rheumatology 2008; 47(6): 877–880.

    Article  PubMed  CAS  Google Scholar 

  36. Nzeusseu A, Durez P, Houssiau F, et al. Successful use of infliximab in a case of refractory juvenile dermatomyositis. Arthritis Rheum 2001; 44: S90.

    Google Scholar 

  37. Roddy E, Couriney PA, Morris A. Non-Hodgkin's lymphoma in a patient with refractory dermatomyositis which had been treated with infliximab [letter]. Rheumatology 2002; 41: 1194–1195.

    Article  PubMed  CAS  Google Scholar 

  38. Norman R, Greenber RG, Jackson JM. Case report of etanercept in inflammatory dermatoses. J Am Acad Dermatol 2006; 54(Suppl 2): S139–142.

    Article  PubMed  Google Scholar 

  39. Hall HA, Zimmermann B. Evolution of dermatomyositis during therapy with a tumor necrosis factor alpha inhibitor. Arthritis Rheum 2006; 55(6): 982–984.

    Article  PubMed  CAS  Google Scholar 

  40. Saadeh CK. Etanercept is effective in the treatment of polymyositis/dermatomyositis which is refractory to conventional therapy including steroids and other disease modifying agents [abstract]. Arthritis Rheum 2000; 43: S193.

    Google Scholar 

  41. Sontheimer RD. Skin manifestations of systemic autoimmune connective tissue disease: diagnostics and therapeutics. Best Pract Res Clin Rheumatol 2004; 18 (3): 429–462.

    PubMed  CAS  Google Scholar 

  42. Liu J, Farmer JD Jr, Lane WS, et al. Calcineurin is a common target of cyclophilin—cyclosporin A and FKBP-FK506 complexes. Cell 1991; 66(4): 807–815.

    Article  PubMed  CAS  Google Scholar 

  43. Oddis C V. Current approach to the treatment of polymyositis and dermatomyositis. Curr Opin Rheumatol 2000; 12(6): 492–497.

    Article  PubMed  CAS  Google Scholar 

  44. Wilkes MR, Sereika SM, Fertig N, et al. Treatment of antisynthetase-associated interstitial lung disease with tacrolimus. Arthritis Rheum 2005; 52(8): 2439–2446.

    Article  PubMed  CAS  Google Scholar 

  45. Ochi S, Nanki T, Takada K, et al. Favorable outcomes with tacrolimus in two patients with refractory interstitial lung disease associated with polymyositis/dermatomyositis. Clin Exp Rheumatol 2005; 23: 707–710.

    PubMed  CAS  Google Scholar 

  46. Mitsui T, Kuroda Y, Kunishige M, et al. Successful treatment with tacrolimus in a case of refractory dermatomyositis. Intern Med 2005; 44(11): 1197–1199.

    Article  PubMed  Google Scholar 

  47. Martín Nalda A, Modesto Caballero C, Arnal Guimeral C, et al. Efficacy of tacrolimus (FK-506) in the treatment of recalcitrant juvenile dermatomyositis: study of 6 cases. Med Clin (Barc) 2006; 127(18): 697–701.

    Google Scholar 

  48. Jorizzo JL. Dermatomyositis: practical aspects. Arch Dermatol 2002; 138: 114–116.

    Article  PubMed  Google Scholar 

  49. Kaplan M. Eculizumab (Alexion). Curr Opin Invest Drugs 2002; 3: 1017–1023.

    CAS  Google Scholar 

  50. Noss EH, Hausner-Sypek DL, Weinblatt ME. Rituximab as therapy for refractory polymyositis and dermatomyositis. J Rheumatol 2006; 33(5): 1021–1026.

    PubMed  Google Scholar 

  51. Konohana A, Kawashima J. Successful treatment of dermatomyositis with dapsone. Clin Exp Dermatol 1994; 19(4): 367.

    Article  PubMed  CAS  Google Scholar 

  52. Cohen JB. Cutaneous involvement of dermatomyositis can respond to dapsone therapy. Int J Dermatol 2002; 41: 182–184.

    Article  PubMed  Google Scholar 

  53. Coleman MD. Dapsone: modes of action, toxicity, and possible strategies for increasing patient tolerance. Br J Dermatol 1993; 129: 507–513.

    Article  PubMed  CAS  Google Scholar 

  54. Dalakas MC, Hohfeld R. Polymyositis and dermatomyositis. Lancet 2003; 362: 971–982.

    Article  PubMed  CAS  Google Scholar 

  55. Choy EH, Isenberg DA. Treatment of dermatomyositis and polymyositis. Rheumatology (Oxford) 2002; 41(1): 7–13.

    Article  CAS  Google Scholar 

  56. Al-Mayouf S, Al-Mazyed A, Bahabri S. Efficacy of early treatment of severe juvenile der-matomyositis with intravenous methylprednisolone and methotrexate. Clin Rheumatol 2000; 19: 138–141.

    Article  PubMed  CAS  Google Scholar 

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(2009). Pharmacologic Agents in the Treatment of DM. In: Dermatomyositis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79313-7_39

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  • DOI: https://doi.org/10.1007/978-3-540-79313-7_39

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