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Therapeutic advances in myositis
Rohit Aggarwal1, Chester V Oddis
1Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. aggarwalr@upmc.edu
Current Opinion in Rheumatology
|September 8, 2012
Summary
Treatment advances for inflammatory myopathies like polymyositis and dermatomyositis are reviewed. Traditional immunosuppressants are effective, though evidence often comes from expert consensus rather than trials.
Area of Science:
- Rheumatology
- Immunology
- Neurology
Background:
- Inflammatory myopathies (IMs) are a group of rare, heterogeneous autoimmune diseases.
- Polymyositis, dermatomyositis, and inclusion body myositis are key types of IMs.
- Limited clinical trials complicate treatment recommendations for IMs.
Purpose of the Study:
- To review recent treatment advances in inflammatory myopathies.
- To evaluate the efficacy of various immunosuppressive and immunomodulatory therapies.
Main Methods:
- Review of existing literature and clinical trial data.
- Analysis of evidence for conventional and novel therapies in IMs.
- Assessment of expert consensus on treatment protocols.
Main Results:
- Corticosteroids are first-line, followed by conventional agents like methotrexate and azathioprine.
- Intravenous immunoglobulin shows short-term benefit; cyclosporine, tacrolimus, and mycophenolate mofetil demonstrate efficacy, particularly in refractory cases and ILD.
- Rituximab and anti-TNF agents have yielded mixed or inconclusive results in trials; newer agents require further investigation.
Conclusions:
- Established immunosuppressive and immunomodulatory drugs are effective for polymyositis and dermatomyositis, despite limited RCT data.
- While newer therapies are under investigation, significant breakthroughs in IM treatment are yet to be realized.
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