Successful treatment of dermatomyositis and associated calcinosis with adalimumab

Abstract

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Advancements in the Treatment of Cutaneous Lupus Erythematosus and Dermatomyositis: A Review of the Literature

“…Cutaneous lesions greatly improved in terms of CDASI only after 4 weeks of therapy. Biologic agents Xie (2020) 63 Case report Adalimumab 40 mg weekly for 4 weeks, followed by q2weeks for 12 weeks. Etanercept 50 mg weekly (medication changed due to pregnancy) Adalimumab 40 mg q2weeks for 18 months, then q4weeks for 6 months, then q6weeks for 6 months 24-year-old female with DM and 3 month history of eyelid swelling and a 1-year history of a nonpruritic erythematous rash affecting her chest, face and arms, associated with migraines and with wrist and phalangeal joint pains Patient had an excellent clinical response within 6 months of treatment, with a reduction in symptoms, skin rash, clearing of Gottron’s papules, increase in muscle bulk and strength, and softening and improvement of calcinosis Campanilho-Marques (2020) 54 Retrospective review Infliximab 6mg/kg q4weeks alone for 12 months OR Adalimumab 24 mg/m 2 q2weeks alone for 12 months OR Infliximab 6mg/kg q4weeks for mean treatment time of 2.3 months followed by Adalimumab 24 mg/m 2 q2weeks for remaining time until 12 months 60 children with juvenile DM with mean age of onset of 5.2 years old.…”

“… 62 A 24-year-old female who received adalimumab 40 mg every 2 to 6 weeks was switched to etanercept 50mg weekly during pregnancy and continued to have improvement in her skin rash and clearing of her Gottron’s papules after 6 total months of treatment. 63 …”

Innate Immunity in Calcinosis Cutis

“…TNF-α inhibitors such as adalimumab and infliximab are widely used for the treatment of autoimmune disorders and may secondarily treat CC lesions given the role of this cytokine in disease mechanisms. In a case report of a DM patient with extensive calcinosis refractory to corticosteroids, IVIG, and rituximab, treatment with adalimumab resulted in an improvement in both CC and DM with maintained remission three years after discontinuing therapy [105]. Interestingly, the patient received etanercept instead of adalimumab during pregnancy, and her treatment response was maintained [105].…”

“…Bisphosphonates -Reduces monocyte/macrophage cell number and viability and induces apoptosis [93] Antibiotics Minocycline Reduces TNF-α, IL-1, and IL-6, inhibits neutrophil chemotaxis, and suppresses of MMP activity [96][97][98] Ceftriaxone Reduces TNF-α and suppresses MMP activity [98] Colchicine -Inhibits neutrophil chemotaxis and NETosis, suppresses NLRP3 inflammasome activation, and reduces proinflammatory cytokine release by macrophages [99,100] Corticosteroids -Reduces pro-inflammatory cytokine release, decreases circulating innate immune cells, and suppresses fibroblast growth and TGF-β1 production Reduces vessel permeability [101,102] IVIG -Suppresses the production of pro-inflammatory cytokines in CD16+ intermediate monocytes Inhibits DC maturation and differentiation, reducing IL-12 secretion and the expression of costimulatory molecules [103,104] Biologics Adalimumab Inhibits TNF-α [105] Infliximab Inhibits TNF-α [106] Abbreviations: DC = dendritic cell; IL = interleukin; IVIG = intravenous immunoglobulin; MMP = matrix metalloprotease; NET = neutrophil extracellular trap; TGF-β1 = transforming growth factor beta 1; TNF-α = tumor necrosis factor alpha.…”

“…In a case report of a DM patient with extensive calcinosis refractory to corticosteroids, IVIG, and rituximab, treatment with adalimumab resulted in an improvement in both CC and DM with maintained remission three years after discontinuing therapy [105]. Interestingly, the patient received etanercept instead of adalimumab during pregnancy, and her treatment response was maintained [105]. Another case report of a patient with SSc/myositis overlap syndrome and recalcitrant calcinosis observed a reduction in the size of CC lesions with no new lesions at 41 months of infliximab therapy [106].…”