Successful Treatment of Refractory Polymyositis with Pulse Intravenous Cyclophosphamide and Low-dose Weekly Oral Methotrexate Therapy.

Hirano, Fuminori; Tanaka, Hirotoshi; Nomura, Yoshinobu; Matsui, Tomoko; Makino, Yuichi; Fukawa, Etsushi; Miura, Takanori; Makino, Isao

doi:10.2169/internalmedicine.32.749

Cited by 12 publications

(5 citation statements)

References 21 publications

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“…The largest of these was that of Cherin et al, 13 who treated tration. 1,45 Reports of the use of intravenous cyclophosphamide in polymyositis have indicated mixed 20 patients with PM or DM who were also on other forms of treatment at the time, including prednisone, results. In one study monthly intravenous administration of the drug in a dose of 750-1250 mg/m 2 was methotrexate, or plasmapheresis, and reported marked clinical improvement in 15 cases.…”

Section: Steroid-resistant Casesmentioning

confidence: 99%

Treatment of inflammatory myopathies

Mastaglia¹,

Phillips²,

Zilko³

1997

Muscle Nerve

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The treatment of the immune‐mediated inflammatory myopathies remains largely empirical. Corticosteroids are usually effective in polymyositis and dermatomyositis but may need to be combined with methotrexate or azathioprine in some patients. Intravenous immunoglobulin (IVIg) is effective as add‐on therapy in some patients not adequately controlled with steroids or immunosuppressive agents, but further controlled trials of IVIg are necessary to define the indications and optimal dose regimens. Cyclophosphamide, cyclosporin, or chlorambucil may be effective in patients with refractory polymyositis or dermatomyositis. Low‐dose whole body or lymphoid irradiation is a last option in severely disabled patients resistant to all other treatments. As a small proportion of patients with inclusion body myositis respond to corticosteroid or immunosuppressive therapy, a 3–6‐month trial of such therapy is justified in this condition. More specific immunotherapy for these disorders awaits identification of the target antigens and further clarification of the immunopathogenetic mechanisms. © 1997 John Wiley & Sons, Inc. Muscle Nerve 20:651–664, 1997.

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Section: Steroid-resistant Casesmentioning

confidence: 99%

Treatment of inflammatory myopathies

Mastaglia¹,

Phillips²,

Zilko³

1997

Muscle Nerve

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“…Intravenous cyclophosphamide pulses in patients with refractory SAM result in improved muscle strength (C) [64,65]. In addition, it is possible that its association with methotrexate normalizes the serum levels of CK (C) [65].…”

Section: How Long Should Sam Patients Receive Immunosuppressive / Immmentioning

confidence: 99%

Guidelines of the Brazilian Society of Rheumatology for the treatment of systemic autoimmune myopathies

et al. 2019

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Background: Recommendations of the Myopathy Committee of the Brazilian Society of Rheumatology for the management and therapy of systemic autoimmune myopathies (SAM). Main body: The review of the literature was done in the search for the Medline (PubMed), Embase and Cochrane databases including studies published until June 2018. The Prisma was used for the systematic review and the articles were evaluated according to the levels of Oxford evidence. Ten recommendations were developed addressing the management and therapy of systemic autoimmune myopathies. Conclusions: Robust data to guide the therapeutic process are scarce. Although not proven effective in controlled clinical trials, glucocorticoid represents first-line drugs in the treatment of SAM. Intravenous immunoglobulin is considered in induction for refractory cases of SAM or when immunosuppressive drugs are contra-indicated. Consideration should be given to the early introduction of immunosuppressive drugs. There is no specific period determined for the suspension of glucocorticoid and immunosuppressive drugs when individually evaluating patients with SAM. A key component for treatment in an early rehabilitation program is the inclusion of strengthbuilding and aerobic exercises, in addition to a rigorous evaluation of these activities for remission of disease and the education of the patient and his/her caregivers.

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“…139 Her symptoms and signs were restricted to swallowing difficulties for 3 years and were successfully treated by oral prednisolone 40 mg daily (evidence level V). Other effective therapies described in case series and single case reports are as follows: IVIg (evidence level V), 140,141 CsA (evidence level V), 142 level V), 143 cricopharyngeal myotomy (evidence level V) 144,145 and endoscopic balloon dilatation (evidence level V). 146…”

Section: Cq17 Will Muscle Weakness In Chronic-stage Myositis Patientmentioning

confidence: 99%

Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists

Kohsaka

Mimori

Kanda

et al. 2018

The Journal of Dermatology

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Although rheumatologists, neurologists and dermatologists see patients with polymyositis (PM) and dermatomyositis (DM), their management appears to vary depending on the physician's specialty. The aim of the present study was to establish the treatment consensus among specialists of the three fields to standardize the patient care. We formed a research team supported by a grant from the Ministry of Health, Labor and Welfare, Japan. Clinical questions (CQ) on the management of PM and DM were raised. A published work search on CQ was performed primarily using PubMed. Using the nominal group technique, qualified studies and results in the published work were evaluated and discussed to reach consensus recommendations. They were sent out to the Japan College of Rheumatology, Japanese Society of Neurology and Japanese Dermatological Association for their approval. We reached a consensus in 23 CQ and made recommendations and a decision tree for management was proposed. They were officially approved by the three scientific societies. In conclusion, a multidisciplinary treatment consensus for the management of PM and DM was established for the first time.

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Successful Treatment of Refractory Polymyositis with Pulse Intravenous Cyclophosphamide and Low-dose Weekly Oral Methotrexate Therapy.

Cited by 12 publications

References 21 publications

Treatment of inflammatory myopathies

Treatment of inflammatory myopathies

Guidelines of the Brazilian Society of Rheumatology for the treatment of systemic autoimmune myopathies

Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists

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