Successful Treatment with Tacrolimus in a Case of Refractory Dermatomyositis

Mitsui, Takao; Kuroda, Yukiko; Kunishige, Makoto; Matsumoto, Toshio

doi:10.2169/internalmedicine.44.1197

Cited by 22 publications

(10 citation statements)

References 9 publications

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“…Considering that some of the clinical manifestations and laboratory data suggestive of active disease, such as muscle weakness, skin symptoms and elevated levels of serum CK, worsened or remained unimproved in all of the patients even with oral PSL alone at the same dosage for at least 1 month, commencement of TAC may have produced additional therapeutic effects on PM/DM. Few case reports have so far described such clinical efficacy of TAC in PM/DM [14-16], and the present study first demonstrated it in a series of patients. The MMT score in some PM patients fluctuated even while they were being treated with PSL and TAC, and full recovery of muscle strength was more frequently seen in DM than in PM.…”

Section: Discussionsupporting

confidence: 63%

Coadministration of tacrolimus with corticosteroid accelerates recovery in refractory patients with polymyositis/ dermatomyositis: a retrospective study

Shimojima

Ishii

Matsuda

et al. 2012

BMC Musculoskelet Disord

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BackgroundTo investigate whether or not coadministration of tacrolimus (TAC) with prednisolone (PSL) can produce a beneficial effect in the treatment of polymyositis/ dermatomyositis (PM/DM).MethodsWe reviewed medical records of 32 PM/DM patients who had been admitted to our hospital, and abstracted those who had received TAC in addition to oral PSL for treatment. The clinical usefulness of TAC in PM/DM was objectively evaluated focusing upon the manual muscle strength test (MMT) score, serum creatine kinase (CK) and tapering of PSL.ResultsNine patients with PM and 6 with DM were enrolled in this study. TAC was added because of difficulty in reduction of PSL in 12 patients and recurrence with corticosteroid-induced complications in the remaining 3. Both PM and DM patients showed significant increases in the MMT score and significant decreases in serum CK 1 to 3 months after starting TAC compared with before. Skin symptoms in a clinically amyopathic DM patient also improved 1 month after starting TAC. The daily dosage of PSL could be significantly reduced in both PM and DM after starting TAC compared with before. No serious adverse events ascribable to TAC occurred in any patients.ConclusionAdditional use of TAC with PSL may safely promote improvement of PM/DM and also accelerate tapering of the latter.

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Section: Discussionsupporting

confidence: 63%

Coadministration of tacrolimus with corticosteroid accelerates recovery in refractory patients with polymyositis/ dermatomyositis: a retrospective study

Shimojima

Ishii

Matsuda

et al. 2012

BMC Musculoskelet Disord

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“…Ciclosporin68 69 70 71 72 73 74 75 76and tacrolimus77 78 79 seem to be effective in some patients but the cost and potential side effects have limited their use in most myositis patients. Side effects of ciclosporin and tacrolimus are renal toxicity, hypertension, electrolyte imbalance, gastrointestinal upset, hypertrichosis, gingival hyperplasia, oncogenicity, tremor and risk of infection.…”

Section: Treatmentmentioning

confidence: 99%

Evaluation and treatment of inflammatory myopathies

Amato

Barohn

2009

Journal of Neurology, Neurosurgery & Psychiatry

109

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The major types of idiopathic inflammatory myopathy include dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM) and immune mediated necrotising myopathy (NM). These myositides appear clinically, histologically and pathogenically distinct. DM, PM and immune mediated NM are responsive to immunosuppressive therapy, in contrast with IBM which is generally refractory to therapy. Greater understanding of the pathogenic bases of these disorders should hopefully lead to better treatment. We need well designed, prospective, double blind, placebo controlled trials in order to determine the best therapeutic options for these different disorders.

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“…It is known to be well tolerated and effective in polymyositis and dermatomyositis, although no placebo-controlled trials have yet been performed [28]. There are also case series showing beneficial effects of tacrolimus and anti-thymocyte globulin [29,30]. In addition, topical cutaneous tacrolimus therapy has also effectively been applied to skin lesions in patients with dermatomyositis [31].…”

Section: T Lymphocytesmentioning

confidence: 99%

Immune mechanisms in the pathogenesis of idiopathic inflammatory myopathies

2007

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Idiopathic inflammatory myopathies (IIMs), comprising polymyositis, dermatomyositis, and inclusion-body myositis, are characterized by inflammatory cell infiltrates in skeletal muscle tissue, muscle weakness, and muscle fatigue. The cellular infiltrates often consist of T lymphocytes and macrophages but also, in some cases, B lymphocytes. Emerging data have led to improved phenotypic characterization of the inflammatory cells, including their effector molecules, in skeletal muscle, peripheral blood, and other organs that are frequently involved, such as skin and lungs. In this review we summarize the latest findings concerning the role of T lymphocytes, B lymphocytes, dendritic cells, and other antigen-presenting cells in the pathophysiology of IIMs.

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Successful Treatment with Tacrolimus in a Case of Refractory Dermatomyositis

Cited by 22 publications

References 9 publications

Coadministration of tacrolimus with corticosteroid accelerates recovery in refractory patients with polymyositis/ dermatomyositis: a retrospective study

Coadministration of tacrolimus with corticosteroid accelerates recovery in refractory patients with polymyositis/ dermatomyositis: a retrospective study

Evaluation and treatment of inflammatory myopathies

Immune mechanisms in the pathogenesis of idiopathic inflammatory myopathies

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