Response of Mucocutaneous Lesions to Rituximab in a Case of Melanoma Differentiation Antigen 5-Related Dermatomyositis

Clottu, Aurélie; Laffitte, Emmanuel; Prins, Christa; Chizzolini, Carlo

doi:10.1159/000346573

Cited by 26 publications

(26 citation statements)

References 31 publications

(54 reference statements)

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“…Moreover, a subsequent subgroup analysis has highlighted that response to rituximab may be influenced by serological phenotype with ASS and antiMi2 patients more likely to gain benefit [122]. A therapeutic role for rituximab within the different clinicoserological phenotypes has been further emphasised in a number of series, including refractory patients with ASS-ILD, anti-MDA5 and anti-SRP disease [117,[123][124][125][126][127][128][129]. Therefore, it seems that stratification based on autoAbs can act as predictive markers of clinical response to treatment, which again highlights their diagnostic utility.…”

Section: Does Clinico-serological Phenotype Influence Outcome and Trementioning

confidence: 99%

The Clinical Features of Myositis-Associated Autoantibodies: a Review

Gunawardena

2015

Clinic Rev Allerg Immunol

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The idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases traditionally defined by clinical manifestations including skeletal muscle weakness, skin rashes, elevated skeletal muscle enzymes, and neurophysiological and/or histological evidence of muscle inflammation. Patients with myositis overlap can develop other features including parenchymal lung disease, inflammatory arthritis, gastrointestinal manifestations and marked constitutional symptoms. Although patients may be diagnosed as having polymyositis (PM) or dermatomyositis (DM) under the IIM spectrum, it is quite clear that disease course between subgroups of patients is different. For example, interstitial lung disease may predominate in some, whereas cutaneous complications, cancer risk, or severe refractory myopathy may be a significant feature in others. Therefore, tools that facilitate diagnosis and indicate which patients require more detailed investigation for disease complications are invaluable in clinical practice. The expanding field of autoantibodies (autoAbs) associated with connective tissue disease (CTD)-myositis overlap has generated considerable interest over the last few years. Using an immunological diagnostic approach, this group of heterogeneous conditions can be separated into a number of distinct clinical phenotypes. Rather than diagnose a patient as simply having PM, DM or overlap CTD, we can define syndromes to differentiate disease subsets that emphasise clinical outcomes and guide management. There are now over 15 CTD-myositis overlap autoAbs found in patients with a range of clinical manifestations including interstitial pneumonia, cutaneous disease, cancer-associated myositis and autoimmune-mediated necrotising myopathy. This review describes their diagnostic utility, potential role in disease monitoring and response to treatment. In the future, routine use of these autoAb will allow a stratified approach to managing this complex set of conditions.

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Section: Does Clinico-serological Phenotype Influence Outcome and Trementioning

confidence: 99%

The Clinical Features of Myositis-Associated Autoantibodies: a Review

Gunawardena

2015

Clinic Rev Allerg Immunol

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“…It has been used with success in some autoimmune diseases, non-Hodgkin lymphomas and, recently, in pemphigus vulgaris [9,10]. Initial successful administration in pemphigus was reported in a patient with follicular non-Hodgkin lymphoma and paraneoplastic pemphigus [11].…”

Section: Introductionmentioning

confidence: 99%

Pilot Study of 19 Patients with Severe Pemphigus: Prophylactic Treatment with Rituximab Does Not Appear to be Beneficial

Gregoriou

Giatrakou²,

Θεοδωρόπουλος³

et al. 2014

Dermatology

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Aims: To assess the efficacy and safety of rituximab in refractory pemphigus and the possible benefit of an additional prophylactic infusion at 6 months. Methods: Seventeen patients with pemphigus vulgaris, 1 with pemphigus foliaceus and 1 with pemphigus vegetans were treated with 4 weekly infusions of rituximab (375 mg/m²). Nine patients received an additional prophylactic infusion after 6 months while the rest received no maintenance therapy. In case of recurrence, an additional single infusion was administered. Results: Control of the disease was obtained after 3-8 weeks. End of the consolidation phase for all patients was observed after 16 weeks. Patients remained in full remission for 7-42 months. All immunosuppressive agents, including prednisone, were discontinued after 2-12 months. The disease relapsed in 5 out of 9 patients who received the additional prophylactic infusion, and in 3 out of 10 patients among those skipping the prophylactic additional infusion. Conclusion: One course of rituximab and treatment of relapses is highly effective and well tolerated in the treatment of refractory pemphigus. In this pilot study of 19 patients, the prophylactic infusion does not appear to have provided any additional benefit to the patients receiving it.

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“…Our findings were in line with those results in that the anti-PL-12 antibody-positive patient survived. However, there are few reports describing the successful treatment of anti-MDA5 antibody-positive patients with RTX (12-14). In our report, in spite of intensive care, including the administration of RTX, the 2 anti-MDA5 antibody-positive patients died.…”

Section: Discussionmentioning

confidence: 99%

“…During the past year, some case series showed the beneficial effects of rituximab (RTX) treatment in anti-ARS antibody-positive DM patients (7-11). In addition, an anti-MDA5 antibody-positive patient displaying the mucocutaneous manifestations of DM who was refractory to IVCY treatment but who improved after the administration of RTX (12), and the successful treatment of 2 anti-MDA5 antibody-positive patients with RTX were recently reported (13,14). However, the efficacy of RTX treatment in DM patients with RP-ILD, including anti-MDA5 antibody-positive patients is still not clear.…”

Section: Introductionmentioning

confidence: 99%

Dermatomyositis with Rapidly Progressive Interstitial Lung Disease Treated with Rituximab: A Report of 3 Cases in Japan

Tokunaga

Hagino

2017

Intern. Med.

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We performed a retrospective chart review of three patients with hypomyopathic dermatomyositis and rapidly progressive interstitial lung disease. The patients were Japanese women of 71, 69, and 65 years of age. Two patients were anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody-positive and 1 was anti-aminoacyl-tRNA synthetase (anti-ARS) antibody-positive. Their respiratory statuses deteriorated despite the administration of glucocorticoid, calcineurin inhibitors, and intravenous cyclophosphamide therapy. We subsequently administered rituximab. The anti-ARS antibody-positive patient survived, while 2 anti-MDA5 antibody-positive patients died.

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Response of Mucocutaneous Lesions to Rituximab in a Case of Melanoma Differentiation Antigen 5-Related Dermatomyositis

Cited by 26 publications

References 31 publications

The Clinical Features of Myositis-Associated Autoantibodies: a Review

The Clinical Features of Myositis-Associated Autoantibodies: a Review

Pilot Study of 19 Patients with Severe Pemphigus: Prophylactic Treatment with Rituximab Does Not Appear to be Beneficial

Dermatomyositis with Rapidly Progressive Interstitial Lung Disease Treated with Rituximab: A Report of 3 Cases in Japan

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