Therapeutic Advances in Myositis
The lack of controlled trial data to guide therapeutic decisions for patients with polymyositis and dermatomyositis continues to plague physicians treating these diseases. Most patients with polymyositis or dermatomyositis require initial treatment with corticosteroids combined with azathioprine or MTX to facilitate subsequent tapering of corticosteroids. In refractory cases, IVIG can be tried, followed by CsA or tacrolimus in patients possessing antisynthetase autoantibodies or ILD or MMF in refractory skin disease. Rituximab appears to be effective in severe and refractory myositis in uncontrolled studies and over 80% of refractory patients improved in the largest myositis trial ever completed despite the primary and secondary end points not being met. Newer emerging treatments like ACTH, toclizumabor etanercept warrant further study. Only multicenter randomized controlled trials involving rheumatologists, dermatologists and neurologists using standardized response criteria will define the optimal therapy in the future.
Conclusion
The lack of controlled trial data to guide therapeutic decisions for patients with polymyositis and dermatomyositis continues to plague physicians treating these diseases. Most patients with polymyositis or dermatomyositis require initial treatment with corticosteroids combined with azathioprine or MTX to facilitate subsequent tapering of corticosteroids. In refractory cases, IVIG can be tried, followed by CsA or tacrolimus in patients possessing antisynthetase autoantibodies or ILD or MMF in refractory skin disease. Rituximab appears to be effective in severe and refractory myositis in uncontrolled studies and over 80% of refractory patients improved in the largest myositis trial ever completed despite the primary and secondary end points not being met. Newer emerging treatments like ACTH, toclizumabor etanercept warrant further study. Only multicenter randomized controlled trials involving rheumatologists, dermatologists and neurologists using standardized response criteria will define the optimal therapy in the future.