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A multicenter prospective study of the efficacy and safety of combined immunosuppressive therapy with high-dose glucocorticoid, tacrolimus, and cyclophosphamide in interstitial lung diseases accompanied by anti-melanoma differentiation-associated gene 5-positive dermatomyositis

Arthritis & Rheumatology Sep 25, 2019

Tsuji H, Nakashima R, Hosono Y, et al. - In view of the often rapid progression and association with poor prognosis of interstitial lung disease (ILD) accompanied by anti-melanoma differentiation-associated gene 5 (MDA5)-positive dermatomyositis (DM), researchers evaluated a combined immunosuppressive regimen for its efficacy and safety in treating anti-MDA5-positive DM with ILD. They treated 29 Japanese patients with newly onset anti-MDA5-positive DM with ILD with a regimen of high-dose glucocorticoids (GC), tacrolimus, and intravenous cyclophosphamide. They used plasmapheresis in cases where worsening occurred following initiation of the regimen. They observed significantly higher 6-month survival in the combined immunosuppressive regimen group vs the step-up treatment group. Outcomes support the efficacy of a combined immunosuppressive regimen for anti-MDA5-positive DM with ILD. In intractable disease, plasmapheresis seemed valuable for achieving the additional effect. They recommended careful monitoring of opportunistic infections during treatment.
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