Therapy for myositis

The management of inflammatory myopathy is a challenge. Although corticosteroids remain the initial therapeutic choice in most instances, their side effects and lack of efficacy are such that alternative modes of therapy are frequently sought. The identification of serum autoantibodies associated with more severe forms of myositis has prompted new classification schemes and has led to more aggressive approaches with combination therapy, using corticosteroids, immunosuppressive drugs, or other immune-modulating agents. Non-corticosteroid agents that provide some benefit include methotrexate, azathioprine, chlorambucil, and perhaps cyclophosphamide. Cyclosporine has been increasingly studied with encouraging results, and intravenous immunoglobulin has demonstrated some benefit for myositis patients. Plasma exchange and leukapheresis were of no proven benefit in a randomized, double-blind trial.