Possible role for tumour necrosis factor inhibitors in the treatment of resistant dermatomyositis and polymyositis: a retrospective study of eight patients
Possible role for tumour necrosis factor inhibitors in the treatment of resistant dermatomyositis and polymyositis: a retrospective study of eight patients
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DOI：
10.1136/ard.2005.048744
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发表时间：
2006-09-01
影响因子：
27.4
通讯作者：
Kagen, L. J.
中科院分区：
文献类型：
--
作者：
Efthimiou, P.;Schwartzman, S.;Kagen, L. J.
目的：了解肿瘤坏死因子（TNF）α抑制剂在难治性皮肌炎和多发性肌炎中的应用。方法：回顾性研究1998年至2004年期间8例皮质类固醇和免疫抑制剂难治性皮肌炎或多发性肌炎患者接受TNF抑制剂治疗。确定了8例皮肌炎或多发性肌炎患者，他们接受TNF抑制剂作为辅助治疗。开始TNF抑制剂治疗前的平均（SD）病程为8.5（4.4）年。患者对皮质类固醇（口服和静脉注射）治疗无效;静脉注射免疫球蛋白和免疫抑制剂（甲氨蝶呤、硫唑嘌呤、mucophenolate mofetil和来氟米特）; TNF治疗前使用了4.5（1.4）种免疫抑制剂。6例患者接受依那西普单药治疗，1例接受英夫利西单抗治疗，1例依次接受两种药物治疗。在8名患者中，6名患者在15.2（6.5）个月后表现出良好的反应，运动强度改善，疲劳减轻。其中2例患者在4（1.4）个月后无应答，停用TNF抑制剂。应答者显示54.4%（27.7%）血清肌酸激酶浓度降低，严重异常（4463.5（4036.4）U/I）。无应答者肌酸激酶浓度也有类似的下降（56.1%（20.4%）），但其治疗前浓度在正常范围内（118.5（9.1）U/I）。结论：抗TNF药物可能是有用的，在一些难治性皮肌炎或多发性肌炎患者。
Objective: To understand the use of tumour necrosis factor (TNF)alpha inhibitors in refractory dermatomyositis and poly-myositis 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/I). 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 (9.1) U/I).Conclusion: Anti-TNF agents may be useful in some patients with refractory dermatomyositis or polymyositis.