A high incidence of disease flares in an open pilot study of infliximab in patients with refractory inflammatory myopathies

Abstract

Infliximab treatment was not effective in refractory inflammatory myopathies. In view of radiological and clinical worsening, and activation of the type I IFN system in several cases, infliximab is not an alternative treatment in patients with treatment-resistant myositis.

Dermatomyositis During Adalimumab Therapy for Rheumatoid Arthritis: Figure 1.

“…There is also evidence that blockage of TNF-α causes exacerbation or prolongation of preexisting autoimmune diseases such as multiple sclerosis in humans and mice 10 . In accord with our findings, Dastmalchi, et al documented a worsening of muscle inflammation during infliximab therapy in patients with DM and polymyositis 11 .…”

Pilot Study of Etanercept in Patients With Refractory Juvenile Dermatomyositis

“…Although the Muscle Study Group demonstrated disease improvement in nearly half of the patients receiving etanercept for adult DM, 5 patients developed a worsening rash while receiving this treatment (8). An open-label study of infliximab in 13 adults with refractory idiopathic inflammatory myopathy demonstrated poor improvement (15). In fact, of the 9 patients who completed this open-label study, at followup, 5 patients demonstrated muscle inflammation by magnetic resonance imaging.…”

Immunotherapies for Immune-Mediated Myopathies: A Current Perspective

“…An open-label study looking at the efficacy of infliximab combined with methotrexate was terminated owing to a low inclusion rate and a high dropout rate due to disease progression or side effects [91]. Another open-label study of infliximab performed in 13 patients with refractory DM/PM/IBM found no patients improved in muscle strength, measured by manual muscle testing, and several patients actually worsened [92]. A study of etanercept in active DM did not show any initial improvement until an additional drug (methotrexate or azathioprine) was added [93].…”