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Possible role for tumour necrosis factor inhibitors in the treatment of resistant dermatomyositis and polymyositis: a retrospective study of eight patients
  1. P Efthimiou1,
  2. S Schwartzman2,
  3. L J Kagen2
  1. 1Division of Allergy, Immunology, and Rheumatology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, New Jersey, USA
  2. 2Department of Medicine, Hospital for Special Surgery, New York, USA; New York Presbyterian Hospital, Weill Medical College of Cornell University, New York
  1. Correspondence to:
    P Efthimiou
    90 Bergen Street, DOC#4700, Newark, NJ 07103, USA; efthimpv{at}umdnj.edu

Abstract

Objective: To understand the use of tumour necrosis factor (TNF)α inhibitors in refractory dermatomyositis and polymyositis in an academic centre.

Methods: A retrospective study of eight patients with dermatomyositis or polymyositis refractory to corticosteroids and immunosuppressives who were treated with TNF inhibitors between 1998 and 2004.

Results: 8 patients with dermatomyositis or polymyositis who were treated with TNF inhibitors as adjunct treatment were identified. The mean (SD) duration of disease before initiation of TNF inhibitors was 8.5 (4.4) years. The patients failed to respond to treatment with corticosteroids (oral and intravenous); intravenous immunoglobulin and immunosuppressants (methotrexate, azathioprine, mucophenolate mofetil and leflunomide); 4.5 (1.4) immunosuppressants had been used before TNF treatment. Six patients were treated with etanercept alone, one with infliximab and one sequentially with both agents. Of the eight patients, six showed a favourable response with improved motor strength and decreased fatigue after 15.2 (6.5) months. Two of the patients did not respond after 4 (1.4) months and TNF inhibitors were discontinued. Responders showed a 54.4% (27.7%) decrease in serum concentration of creatine kinase, which was grossly abnormal (4463.5 (4036.4) U/l). Non-responders had similar reductions in creatine kinase concentration (56.1% (20.4%)), but their pre-treatment concentrations were in the normal range (118.5 (19.1) U/l).

Conclusion: Anti-TNF agents may be useful in some patients with refractory dermatomyositis or polymyositis.

  • DMARD, disease-modifying antirheumatic drug
  • IBM, inclusion-body myositis
  • IFN, interferon
  • IIM, idiopathic inflammatory myopathy
  • TNF, tumour necrosis factor

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Footnotes

  • Published Online First 13 February 2006

  • Competing interests: SS is a member of the Speaker’s Bureau for Centocor, Wyeth/Amgen, and Abbott Immunology. PE and LJK have no conflicts of interest.

  • This was an oral presentation (OP0032) at the 2004 EULAR Meeting, Berlin, Germany.

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