The efficacy of calcineurin inhibitors for the treatment of interstitial lung disease associated with polymyositis/dermatomyositis

Kurita, Takashi; Yasuda, Shinsuke; Amengual, Olga; Atsumi, Tatsuya

doi:10.1177/0961203314554849

Cited by 37 publications

(23 citation statements)

References 79 publications

(113 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent retrospective study of 49 Japanese patients with PM/DM-ILD comparing outcomes in patients who received conventional therapy (prednisone with intravenous cyclophosphamide or ciclosporin) versus those who received conventional therapy and tacrolimus found significant improvements in event-free survival in those patients who received tacrolimus. 108 However, as noted in an accompanying editorial, the results may not be generalizable to other populations given the high prevalence of anti-MDA-5-positive disease (40% of IIM-ILD in Japan in one study), a particularly aggressive form of CTD-ILD. 109 110 Furthermore, because more patients in the tacrolimus group received cyclophosphamide, it is unclear whether the improved outcomes were related to cyclophosphamide or tacrolimus.…”

Section: Calcineurin Inhibitorsmentioning

confidence: 86%

Management of interstitial lung disease associated with connective tissue disease

Mathai

Danoff

2016

BMJ

250

205

View full text Add to dashboard Cite

The lung is a common site of complications of systemic connective tissue disease (CTD), and lung involvement can present in several ways. Interstitial lung disease (ILD) and pulmonary hypertension are the most common lung manifestations in CTD. Although it is generally thought that interstitial lung disease develops later on in CTD it is often the initial presentation ("lung dominant" CTD). ILD can be present in most types of CTD, including rheumatoid arthritis, scleroderma, systemic lupus erythematosus, polymyositis or dermatomyositis, Sjögren's syndrome, and mixed connective tissue disease. Despite similarities in clinical and pathologic presentation, the prognosis and treatment of CTD associated ILD (CTD-ILD) can differ greatly from that of other forms of ILD, such as idiopathic pulmonary fibrosis. Pulmonary hypertension (PH) can present as a primary vasculopathy in pulmonary arterial hypertension or in association with ILD (PH-ILD). Therefore, detailed history, physical examination, targeted serologic testing, and, occasionally, lung biopsy are needed to diagnose CTD-ILD, whereas both non-invasive and invasive assessments of pulmonary hemodynamics are needed to diagnose pulmonary hypertension. Immunosuppression is the mainstay of treatment for ILD, although data from randomized controlled trials (RCTs) to support specific treatments are lacking. Furthermore, treatment strategies vary according to the clinical situation-for example, the treatment of a patient newly diagnosed as having CTD-ILD differs from that of someone with an acute exacerbation of the disease. Immunosuppression is indicated only in select cases of pulmonary arterial hypertension related to CTD; more commonly, selective pulmonary vasodilators are used. For both diseases, comorbidities such as sleep disordered breathing, symptoms of dyspnea, and cough should be evaluated and treated. Lung transplantation should be considered in patients with advanced disease but is not always feasible because of other manifestations of CTD and comorbidities. Clinical trials of novel therapies including immunosuppressive therapies are needed to inform best treatment strategies.

show abstract

Section: Calcineurin Inhibitorsmentioning

confidence: 86%

Management of interstitial lung disease associated with connective tissue disease

Mathai

Danoff

2016

BMJ

250

205

View full text Add to dashboard Cite

show abstract

“…A number of studies have suggested a potential role for calcineurin inhibitors, especially tacrolimus as a first-line and rescue treatment in ILDassociated ASS [109][110][111][112]. Similar regimes have been described in amyopathic DM RP-ILD, including efficacy of combination therapy with cyclosporine and cyclophosphamide [112][113][114][115]. Additional second-line treatments for muscle, skin and subcutaneous disease in other phenotypes include methotrexate, azathioprine and MMF, and in refractory cases intravenous immunoglobulin.…”

Section: Does Clinico-serological Phenotype Influence Outcome and Trementioning

confidence: 97%

“…Use of the former two agents is essentially based on clinical best practice using experience adopted in other conditions such as systemic sclerosis, as well as retrospective observational studies [106][107][108]. A number of studies have suggested a potential role for calcineurin inhibitors, especially tacrolimus as a first-line and rescue treatment in ILDassociated ASS [109][110][111][112]. Similar regimes have been described in amyopathic DM RP-ILD, including efficacy of combination therapy with cyclosporine and cyclophosphamide [112][113][114][115].…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Other myositis-associated antibodies, such as anti-MDA-5, anti-PM-SCL, and anti-Ro-52 are also associated with a higher risk of ILD as well as typical clinical phenotypes. The association between clinically amyopathic dermatomyositis (CADM), anti-MDA-5 positivity, and acute and/or rapidly progressive ILD, which all portend high mortality and poor response to immunosuppression(41, 42) is one of the most prognostically significant, especially in patients of East Asian descent.…”

Section: Treatment Of Ctd-ildmentioning

confidence: 99%

Management of connective tissue diseases associated interstitial lung disease

Wallace

Vummidi

Khanna

2016

Current Opinion in Rheumatology

View full text Add to dashboard Cite

Purpose of review Interstitial lung disease (ILD), though a common and often a severe manifestation of many connective tissue diseases (CTD), is challenging to manage due to its variable presentation and the relative lack of guidelines to assist the clinician. In this review, we discuss the approach to diagnosis, treatment, and monitoring patients with CTD-associated ILD, with a focus on systemic sclerosis (SSc), rheumatoid arthritis (RA), and idiopathic inflammatory myopathy (IIM). Recent findings High-resolution CT scan and pulmonary function testing can be reliably used to diagnose ILD and monitor progression, and often to determine its likely histologic subtype and severity. In SSc-ILD, randomized controlled trials show ILD stabilization with cyclophosphamide treatment; preliminary data from another randomized controlled trial demonstrates similar findings with mycophenolate. There are no robust clinical trials supporting specific treatments for RA-ILD or IIM-ILD, but rituximab in RA-ILD, and cyclophosphamide, mycophenolate and calcineurin inhibitors in IIM-ILD show promise. Summary Though ILD contributes substantially to morbidity and mortality in patients with CTD, there is minimal data to guide its management except in SSc-ILD.

show abstract

The efficacy of calcineurin inhibitors for the treatment of interstitial lung disease associated with polymyositis/dermatomyositis

Cited by 37 publications

References 79 publications

Management of interstitial lung disease associated with connective tissue disease

Management of interstitial lung disease associated with connective tissue disease

The Clinical Features of Myositis-Associated Autoantibodies: a Review

Management of connective tissue diseases associated interstitial lung disease

Contact Info

Product

Resources

About