Pilot Study of Etanercept in Patients With Refractory Juvenile Dermatomyositis

Rouster‐Stevens, Kelly; Ferguson, Lori; Morgan, Gabrielle; Huang, Chiang Ching; Pachman, Lauren M.

doi:10.1002/acr.22198

Cited by 61 publications

(34 citation statements)

References 18 publications

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“…With regard to anti-TNFα agents, available data are conflicting: some studies and case reports seem to indicate them as having an effective role in such patient [63][64][65][66][67][68], while other studies seem to state just the opposite [69][70][71][72][73]. In particular, according to many case reports, infliximab can lead to clinical benefit in myositis patients [63][64][65].…”

Section: Biological Therapiesmentioning

confidence: 97%

See 1 more Smart Citation

Idiopathic Inflammatory Myopathies: an Update on Classification and Treatment with Special Focus on Juvenile Forms

Pagnini

Vitale

Selmi

et al. 2015

Clinic Rev Allerg Immunol

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Juvenile inflammatory myopathies represent a heterogeneous group of rare and potentially fatal disorders of unknown aetiology, characterised by inflammation and proximal and symmetric muscle weakness. Beyond many similarities, specific clinical, laboratoristic and histopathologic features underlie different subsets with distinguishing demographic, prognostic and therapeutic peculiarities. Over time, several forms of inflammatory idiopathic myopathies have been described, including macrophagic myofascitis, immune-mediated necrozing myopathy and the spectrum of amyopathic dermatomyositis that include hypomyopathic dermatomyositis, inclusion body myositis and cancer-associated myositis occurring almost exclusively in adults. However, juvenile dermatomyositis is the most frequent in childhood, whereas polymyositis is relatively more frequent in adults. The aetiology is nowadays widely unclear; however, current theories contemplate a combination of environmental triggers, immune dysfunction and specific tissue responses involving muscle, skin and small vessels endothelium in genetically susceptible individuals. Myositis-specific autoantibodies, found almost exclusively in patients with myositis and myositis-associated autoantibodies, detectable both among patients with myositis and in subjects suffering from other autoimmune diseases, have an important clinical role because of their relation to specific clinical features, response to therapy and prognosis. The gold standard treatment for juvenile dermatomyositis is represented by corticosteroids, along with adjunctive steroid-sparing immunosuppressive therapies, which are used to counteract disease activity, prevent mortality, and reduce long-term disability. Further treatment approach such as biologic agents and autologous stem cell transplantation are emerging during the last years, in particular in patients difficult to treat and with poor prognosis. Therefore, a highly medical specialised approach is required for diagnosis and management of these conditions. This review comprehensively examines juvenile inflammatory myopathies focusing on clinical and laboratory classifications as well as on the current treatment approaches, referring in particular on biologic agents and latest therapeutic opportunities.

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Section: Biological Therapiesmentioning

confidence: 97%

“…Only six out of nine patients completed the study. Furthermore, there was no significant change in serum muscle enzymes or Childhood Myositis Assessment Scale throughout the study [72]. Similarly, a case series reporting five DM patients showed etanercept ineffectiveness as all patients experienced an exacerbation of disease [73].…”

Section: Biological Therapiesmentioning

confidence: 97%

Idiopathic Inflammatory Myopathies: an Update on Classification and Treatment with Special Focus on Juvenile Forms

Pagnini

Vitale

Selmi

et al. 2015

Clinic Rev Allerg Immunol

View full text Add to dashboard Cite

show abstract

“…TNF may suppress type I interferon production; therefore, anti-TNFs could potentially worsen disease by opposing this action 41. An open-label study of etanercept in refractory JDM showed mixed results with some patients worsening on treatment and improving after withdrawal 42. There is, however, stronger evidence for use of rituximab.…”

Section: Introductionmentioning

confidence: 99%

New age of biological therapies in paediatric rheumatology

Sen

Ramanan

2014

Archives of Disease in Childhood

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Many paediatric rheumatic diseases result from the abnormal activation or control of the immune system. Biologic drugs, which are synthesised within a biological system, have been designed to target specific molecules involved in cytokine signalling or cell-cell interactions. The past 15 years have seen a revolution in the range of effective treatments for rheumatic diseases, particularly juvenile idiopathic arthritis (JIA). As a result, the target of inactive disease and minimal long-term disease-associated damage is increasingly becoming achievable. In this article we review evidence from recent trials of the use of biologic drugs in the treatment of systemic JIA, juvenile dermatomyositis and juvenile systemic lupus erythematosus. We also highlight novel agents currently undergoing investigation which may broaden our therapeutic armamentarium over the coming decade. Key to these developments are well-designed multicentre controlled clinical trials and long-term safety monitoring as part of international drug registries.

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“…They suggested that caution should be taken when recommending TNF receptor inhibitors to patients with active symptoms of JDM; close follow-up is warranted. Further investigation of the interaction of the TNFα-308A polymorphism and type 1 interferon is needed to define the mechanism of TNF blockade in JDM [27].…”

Section: -Dermatomyositismentioning

confidence: 99%

“…There are reports of alleviation of both the skin and muscle symptoms of DM with the use of etanercept. The authors suggest using caution when prescribing TNF-α antagonists to patients with syndromes known to have a paraneoplastic association [25,26,27]. A randomized, pilot trial of etanercept in dermatomyositis were done by Muscle Study Group in 2011.…”

Section: -Dermatomyositismentioning

confidence: 99%

Off-Label Dermatological Uses of Etanercept Treatment

2016

J turk acad dermatol

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Background: Tumor necrosis factor-alpha (TNF-α) is a proinflammatory cytokine that plays an immunomodulatory role in a variety of systemic and dermatologic disease. Its blockade can be achieved by using specific inhibitors like etanercept. At present, etanercept is approved for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis and psoriasis treatment. However, it has been used with promising results in other inflammatory dermatoses. Etanercept treatment have been reported in the following dermatologic diseases: sarcoidosis, hidradenitis suppurativa, acne vulgaris, cicatricial pemphigoid, pemphigus vulgaris, Hailey-Hailey disease, Behçet' s disease, oral aphthous stomatitis, pyoderma gangrenosum, multicentric reticulohistiocytosis, apthous stomatitis, Sneddon-Wilkinson disease, acrodermatitis continua of Hallopeau, SAPHO syndrome, pityriasis rubra pilaris, vitiligo, necrobiosis lipoidica, silicone granulomas, Sweet's syndrome, atopic dermatitis, dyshidrotic eczema, toxic epidermal necrolysis, alopecia areata, centrifugal annular erythema, primary amyloidosis, erythroderma-related pruritus in Sézary syndrome, cutaneous T-cell lymphoma, inflammatory linear verrucous epidermal nevus, excessive scarring, postherpetic neuralgia, dermatomyositis, vasculitis, lupus erythematosus, and scleroderma. The vast majority of these reports are in the form of individual case reports and small case series. A growing number of published reports suggest that etanercept treatment may be effective in the treatment of numerous inflammatory skin disease outside their currently approved indications.

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Pilot Study of Etanercept in Patients With Refractory Juvenile Dermatomyositis

Cited by 61 publications

References 18 publications

Idiopathic Inflammatory Myopathies: an Update on Classification and Treatment with Special Focus on Juvenile Forms

Idiopathic Inflammatory Myopathies: an Update on Classification and Treatment with Special Focus on Juvenile Forms

New age of biological therapies in paediatric rheumatology

Off-Label Dermatological Uses of Etanercept Treatment

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