Combined immunosuppressive therapy provides favorable prognosis and increased risk of cytomegalovirus reactivation in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis.
Adult
Autoantibodies
/ blood
Cytomegalovirus
/ immunology
Cytomegalovirus Infections
/ diagnosis
Dermatomyositis
/ blood
Disease Progression
Drug Therapy, Combination
/ adverse effects
Female
Humans
Immunosuppressive Agents
/ administration & dosage
Incidence
Interferon-Induced Helicase, IFIH1
/ immunology
Japan
Lung Diseases, Interstitial
/ diagnosis
Male
Middle Aged
Prognosis
Retrospective Studies
Virus Activation
/ drug effects
Vital Capacity
/ drug effects
anti-melanoma differentiation-associated gene 5 antibody
combined immunosuppressive therapy
cytomegalovirus
dermatomyositis
interstitial lung disease
Journal
The Journal of dermatology
ISSN: 1346-8138
Titre abrégé: J Dermatol
Pays: England
ID NLM: 7600545
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
04
11
2019
accepted:
26
01
2020
pubmed:
26
2
2020
medline:
9
2
2021
entrez:
26
2
2020
Statut:
ppublish
Résumé
Anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab) is myositis-specific autoantibody associated with rapidly progressive interstitial lung disease (ILD) and poor prognosis. In this retrospective observational study, we aimed to verify the efficacy and safety of introducing combined immunosuppressive therapy for anti-MDA5 Ab-positive dermatomyositis (DM) from their early stage. We recruited all Japanese patients diagnosed with DM in our clinic between January 2011 and October 2018, who had anti-MDA5 Ab, anti-aminoacyl transfer RNA synthetase Ab or anti-transcriptional intermediary factor 1-γ Ab. Combined immunosuppressive therapy was defined as combination of systemic corticosteroids, i.v. cyclophosphamide and tacrolimus. The difference of clinical features among the three groups was analyzed by multiple comparison analysis. The longitudinal change of the measurements from baseline was examined by Wilcoxon signed-rank test. Association between therapeutic regimens and adverse events was examined by logistic regression analysis. As a result, combined immunosuppressive therapy was most frequently used in the anti-MDA5 Ab-positive group, which significantly improved their forced vital capacity of the lung. Interval time since initial visit until starting treatment was the shortest in the anti-MDA5 Ab-positive group. There was no significant difference in the incidence of death and recurrence among the three groups. Cytomegalovirus reactivation was most common in the anti-MDA5 Ab-positive group, associated with combined immunosuppressive therapy. Collectively, early introduction of combined immunosuppressive therapy was effective for DM patients with anti-MDA5 Ab. At the same time, clinicians should be aware of the risk of cytomegalovirus reactivation during the treatment.
Identifiants
pubmed: 32096271
doi: 10.1111/1346-8138.15274
doi:
Substances chimiques
Autoantibodies
0
Immunosuppressive Agents
0
IFIH1 protein, human
EC 3.6.1.-
Interferon-Induced Helicase, IFIH1
EC 3.6.4.13
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
483-489Informations de copyright
© 2020 Japanese Dermatological Association.
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