Successful multi‐target therapy including rituximab and mycophenolate mofetil in anti‐melanoma differentiation‐associated gene 5 antibody‐positive rapidly progressive interstitial lung disease with clinically amyopathic dermatomyositis

Hisanaga, Jumpei; Kotani, Takuya; Fujiki, Youhei; Takeuchi, Tohru; Makino, Shigeki

doi:10.1111/1756-185x.13136

Cited by 23 publications

(13 citation statements)

References 9 publications

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“…Anti-MDA5 antibodies have also been associated with RP-ILD, as identified in 39%-100% of patients with RP-ILD in Asian cohorts (15). The cumulative 6-month survival rate was reported to be about 50% for RP-ILD patients with the anti-MDA5 antibody (16). Hence, anti-MDA5 antibodies can be a useful predictor for the complication of RP-ILD in patients with CADM.…”

Section: Discussionmentioning

confidence: 98%

Case Report: Rapidly Progressive Interstitial Lung Disease in A Pregnant Patient With Anti-Melanoma Differentiation-Associated Gene 5 Antibody-Positive Dermatomyositis

Chen

Huang

et al. 2021

Front. Immunol.

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Dermatomyositis occurs extremely rarely during pregnancy. A number of studies in the published literature have documented how the outcome of pregnancy is poor for both mother and fetus. The present case study reports on a patient who was diagnosed with clinically amyopathic dermatomyositis complicated by interstitial lung disease during pregnancy, and was successfully treated with a combined immunosuppressant regimen. To the best of the authors’ knowledge, this is the first case study detailing how a pregnant woman with clinically amyopathic dermatomyositis with positive anti-melanoma differentiation-associated gene 5 antibody achieved complete remission after early intervention of combined immunosuppressive therapy without residual pulmonary interstitial changes.

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Section: Discussionmentioning

confidence: 98%

Case Report: Rapidly Progressive Interstitial Lung Disease in A Pregnant Patient With Anti-Melanoma Differentiation-Associated Gene 5 Antibody-Positive Dermatomyositis

Chen

Huang

et al. 2021

Front. Immunol.

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“…In searching the database PubMed from 1993 to June. 2019 using terms “anti-MDA5 antibody AND (blood purification OR hemoperfusion OR plasmapheresis OR plasma exchange OR plasma absorption OR immunoadsorption)”, 9 essays [[14], [15], [16], [17], [18], [19], [20], [21], [22]] (8 cases report and 1 article [16]) are implicated in CADM-RFIP with a positive anti-MDA5 antibody, but the patients involved in that article could also found in the other cases reports. For this reason, we just exhibit a total of 10 CADM patients with anti-MDA 5 antibody positive, including ours.…”

Section: Discussionmentioning

confidence: 99%

“…Once diagnosed with CADM, most patients were treated with high-dose corticosteroid (1 mg/kg/day)pulse therapy combined with cyclophosphamide and cyclosporin A. During the blood purification, 6 patients [14,15,17,18,21,22] were with direct hemoperfusion using a polymyxin B-immobilized fiber column (one was with PMX only [21]) and two of them died. Four patients were treated with plasma exchange [[19], [20], [21]] and two of them suggested favorable outcome [[17], [21]].…”

Section: Discussionmentioning

confidence: 99%

“…The remained two patients in our department received DNA adsorption and showed ameliorated symptoms. In the maintenance therapy later, 3 patients received methylprednisolone along with cyclophosphamide, two were treated with PMX-DHP/intravenous immunoglobulin with tacrolimus [15,18], one received mycophenolate combined with rituximab [14], one was with tofacitinib [20], and the remainder maintenance therapy can't be found in the essay [19,22]. Ultimately, 8 patients were out of the hospital but Case 2 in our institution died later.…”

Section: Discussionmentioning

confidence: 99%

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Blood purification in two patients with clinically amyopathic dermatomyositis associated with interstitial lung disease with anti-melanoma differentiation-associated gene-5 antibody (MDA-5)

Shi

Li²,

Wei³

et al. 2019

Respiratory Medicine Case Reports

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Patients of clinically amyopathic dermatomyositis associated with rapidly progressive interstitial pneumonia (CADM-RFIP) with positive anti-MDA5 antibody usually presents rapid deterioration and traditional therapy such as cyclophosphamide combined with high-dose prednisone pulse therapy shows no clear benefit at whiles. However, blood purification combined with traditional therapy works according to the literature. We herein report two CADM-RFIP patients administered with DNA immunoadsorption combined with traditional therapy and then reviewed the literature of blood purification in CADM-RFIP patients at home and abroad to date. We emphasize blood purification such as DNA immunoadsorption could apply in the early stage of CADM-RFIP, which can decrease inflammation and allow us more time to control the condition better.

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“…[ 5 ] More effective treatments for RPILD patients with anti-MDA5 Ab-positive DM are strongly desired. In some cases, immunosuppressive treatments such as mycophenolate mofetil (MMF) and rituximab (RTX) may be effective for this disease, [ 6 , 7 ] but the efficacy of these treatments has not yet been fully established.…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of plasma exchange for rapidly progressive interstitial lung disease with anti-MDA5 antibody-positive dermatomyositis

Endo

Koga

Suzuki³

et al. 2018

Medicine

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Rationale:As the initial treatment of rapidly progressive interstitial lung disease (RPILD) with antimelanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab)-positive dermatomyositis (DM) patients, a combination of corticosteroids, cyclophosphamide, and calcineurin inhibitor is recommended. However, some of these patients have poor prognoses despite such intensive treatment. Other more effective treatments are desired. We report the case of an anti-MDA5 Ab-positive DM patient who had developed RPILD despite intensive treatments; she was treated successfully by a short-term plasma exchange (PE).Patient concerns:A 71-year-old Japanese woman was admitted to the rheumatology department of another hospital with progressive muscle weakness of the limbs and erythema on both upper eyelids and the fingers of both hands. She was suspected of having classical DM (CDM) based on the findings of typical skin and myositis. Although a chest computed tomography (CT) examination showed no findings of interstitial pneumonia at the first visit to the department, she newly presented interstitial pneumonia during her admission and her anti-MDA5 Ab titer was elevated.Diagnoses:She was diagnosed with interstitial lung disease (ILD) with anti-MDA5 Ab-positive DM.Interventions:She was treated with 1000 mg of methyl-prednisolone pulse, 500 mg of intravenous cyclophosphamide therapy (IVCY) followed by prednisolone 40 mg/day with tapering, and oral cyclosporine 200 mg/day. However, her interstitial pneumonia worsened with increasing breathing difficulty and an increasing serum ferritin level. She was transferred to our department, and we initiated PE as an additional treatment.Outcomes:After the PE treatment, all laboratory findings, for example, ferritin, KL-6, and the titer of anti-MDA5 Ab showed marked improvement, and the patient's skin symptoms and active interstitial pneumonia were relieved.Lessons:Our patient's case suggests that PE may be effective for RPILD in anti-MDA5 Ab-positive DM patients.

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Successful multi‐target therapy including rituximab and mycophenolate mofetil in anti‐melanoma differentiation‐associated gene 5 antibody‐positive rapidly progressive interstitial lung disease with clinically amyopathic dermatomyositis

Cited by 23 publications

References 9 publications

Case Report: Rapidly Progressive Interstitial Lung Disease in A Pregnant Patient With Anti-Melanoma Differentiation-Associated Gene 5 Antibody-Positive Dermatomyositis

Case Report: Rapidly Progressive Interstitial Lung Disease in A Pregnant Patient With Anti-Melanoma Differentiation-Associated Gene 5 Antibody-Positive Dermatomyositis

Blood purification in two patients with clinically amyopathic dermatomyositis associated with interstitial lung disease with anti-melanoma differentiation-associated gene-5 antibody (MDA-5)

Successful treatment of plasma exchange for rapidly progressive interstitial lung disease with anti-MDA5 antibody-positive dermatomyositis

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