Combined immunosuppressive therapy provides favorable prognosis and increased risk of cytomegalovirus reactivation in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis
Combined immunosuppressive therapy provides favorable prognosis and increased risk of cytomegalovirus reactivation in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis
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DOI：
10.1111/1346-8138.15274
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发表时间：
2020-02-24
影响因子：
3.1
通讯作者：
Sato, Shinichi
中科院分区：
文献类型：
--
作者：
Matsuda, Kazuki M.;Yoshizaki, Ayumi;Sato, Shinichi
抗黑色素瘤分化相关基因5（MDA 5）抗体（Ab）是肌炎特异性自身抗体，与快速进展的间质性肺疾病（ILD）和不良预后相关。在这项回顾性观察性研究中，我们的目的是验证从抗MDA 5 Ab阳性皮肌炎（DM）的早期阶段引入联合免疫抑制治疗的有效性和安全性。我们招募了2011年1月至2018年10月期间在我们诊所诊断为DM的所有日本患者，这些患者具有抗MDA 5 Ab、抗氨酰转移RNA合成酶Ab或抗转录中间因子1-γ Ab。联合免疫抑制治疗定义为全身性皮质类固醇、静脉注射环磷酰胺和他克莫司的联合治疗。采用多重比较分析3组患者临床特征的差异。通过Wilcoxon符号秩检验检查测量值较基线的纵向变化。治疗方案和不良事件之间的关联进行了logistic回归分析。因此，抗MDA 5 Ab阳性组最常使用联合免疫抑制治疗，这显著改善了他们的肺用力肺活量。抗MDA 5 Ab阳性组从首次访视至开始治疗的间隔时间最短。三组患者的死亡率和复发率差异无统计学意义。巨细胞病毒再激活在抗MDA 5 Ab阳性组中最常见，与联合免疫抑制治疗相关。总的来说，早期引入联合免疫抑制治疗对抗MDA 5抗体阳性的DM患者有效。同时，临床医生应了解治疗过程中巨细胞病毒再激活的风险。
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-gamma 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.