Cyclosporine A as treatment of esophageal involvement in dermatomyositis

Mii, Sumiyuki; Niiyama, Shiro; Kusunoki, Mai; Arai, Satoru; Katsuoka, Kensei

doi:10.1007/s00296-006-0168-6

Cited by 13 publications

(8 citation statements)

References 10 publications

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“…Favorable outcomes to first-line IS therapy (ie, MTX, azathioprine) in combination with steroids in patients who failed to respond to steroids alone have been reported in many cases. CsA has been effective in DM-associated dysphagia [51]. Marie et al [52] retrospectively evaluated 73 patients (39 PM, 34 DM) with steroid-resistant esophageal involvement treated with IVIG.…”

Section: Esophageal Dysphagiamentioning

confidence: 99%

Therapeutic Approaches in Myositis

Aggarwal

Oddis

2011

Curr Rheumatol Rep

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The inflammatory myopathies are a heterogeneous group of diseases including dermatomyositis, polymyositis, and inclusion body myositis. Few clinical trials have been conducted in myositis, making it difficult to provide clear recommendations on the treatment of these rare disorders. Although corticosteroids have not been tested in randomized controlled trials, the general expert consensus confirms their first-line use. However, in many patients, corticosteroid toxicity leads to significant disability, or these agents are ineffective, which then requires additional immunosuppression. Intravenous immunoglobulin is a reasonable short-term treatment with proven benefit in a controlled trial, but its long-term effectiveness remains unknown. The evidence for other immunosuppressive therapies has been derived mainly from case reports and open studies. These agents include methotrexate and/or azathioprine, followed by cyclosporine or tacrolimus (particularly for antisynthetase antibody-positive patients) and mycophenolate mofetil (for refractory rash). Newer therapies (eg, rituximab) are encouraging, but results from the largest randomized controlled trial studying this agent are soon to follow. The balance of evidence suggests that immunosuppressive drugs are effective in dermatomyositis and polymyositis, although randomized controlled trials are lacking.

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Section: Esophageal Dysphagiamentioning

confidence: 99%

Therapeutic Approaches in Myositis

Aggarwal

Oddis

2011

Curr Rheumatol Rep

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“…In addition, in a RCT on 36 patients (20 with DM, 16 with PM), CyA has been shown to be as effective as MTX [117]. In literature there are reports about CyA efficacy in managing DMassociated oesophageal involvement [118]. A growing body of evidence suggests the beneficial effect of CyA in the management of ILD [119][120][121][122][123], also in cases resistant to steroid treatment [124,125] and those with an acute onset [126].…”

Section: Cyclosporine a In Inflammatory Myopathiesmentioning

confidence: 99%

The Use of Cyclosporine A in Rheumatology: a 2016 Comprehensive Review

Chighizola

Ong

Meroni

2016

Clinic Rev Allerg Immunol

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Cyclosporine A, an inhibitor of calcineurin, exerts an immunomodulator action interfering with T cell activation. Even though novel therapeutic tools have emerged, CyA still represents a suitable option in several clinical rheumatology settings. This is the case of refractory nephritis and cytopenias associated with systemic lupus erythematosus. Furthermore, CyA is a valued therapeutic tool in the management of uveitis and thrombophlebitis in course of Behçet's disease. Topical CyA has been proven to be beneficial in the dry eye of Sjogren's syndrome, whereas oral treatment with CyA can be considered for the severe complications of adult onset Still's disease. CyA provides a therapeutic option in psoriatic arthritis, being rather effective in skin disease. CyA is currently regarded as a second-line option for patients with inflammatory myopathies refractory to standard regimen. CyA is used even in paediatric rheumatology, in particular in the management of juvenile dermatomyositis and macrophage activation syndrome associated with systemic juvenile idiopathic arthritis. Importantly, CyA has been shown to suppress the replication of HCV, and it can thus be safely prescribed to those patients with chronic hepatitis C. Noteworthy, CyA can be administered throughout the gestation course. Surely, caution should be paid to CyA safety profile, in particular to its nephrotoxicity. Even though most evidence comes from small and uncontrolled studies with few randomised controlled trials, CyA should be still regarded as a valid therapeutic tool in 2016 rheumatology.

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“…Cyclosporine at a dose of 1 mg/kg/day combined with prednisone for 1 month was effective in treating dermatomyositis with esophageal involvement, with cyclosporine acting as a steroid-sparing agent, allowing the dose of prednisone to be tapered gradually. 110 The interstitial lung disease and pneumomediastinum associated with dermatomyositis improved after 2 months of cyclosporine 1.8 mg/kg/day and prednisone 40 mg/day. 111 Cyclosporine doses of more than 200 mg/day and prednisone improves the prognosis of patients with dermatomyositis associated with subacute interstitial pneumonia when initiated within 15 days of diagnosis.…”

Section: Dermatomyositismentioning

confidence: 98%