Immunosuppression for dermatomyositis and polymyositis
Sübutlu məlumatların xülasələri
02.10.2017 • Sonuncu dəyişiklik 02.10.2017
Editors
The evidence is lacking about the use of immunosuppressant and immunomodulatory agents in dermatomyositis and polymyositis.
A Cochrane review included 10 studies with a total of 258 subjects. They had either dermatomyositis and polymyositis, muscle biopsy was used in 5 trials for diagnosis. The interventions studied included the following: intravenous immunoglobulin (IVIg), plasma exchange,
azathioprine,
prednisolone,
methotrexate, ciclosporin,
infliximab,
eculizumab, oral dexamethasone and etanercept, either alone or in combinations.
- Immunosuppressant vs placebo (6 studies): One study (n=15) investigating IVIg found an MD of 9.50 (95% CI 4.33 to 14.67) in improvement in muscle strength between the groups over 3 months. Another study investigating etanercept (n=16) showed that median time to treatment failure, a secondary outcome, was 148 days in the placebo vs. 358 days in the etanercept arm (p=0.0002), but no improvement in other assessed outcomes was seen.
- The other 4 RCTs assessed either plasma exchange and leukapheresis, eculizumab, infliximab or azathioprine against placebo and all produced negative results.
Three of the 4 studies comparing two immunosuppressant regimes (azathioprine with methotrexate, ciclosporin with methotrexate, and intramuscular methotrexate with oral methotrexate plus azathioprine) showed no difference in efficacy between the treatment regimes. The fourth study comparing pulsed oral dexamethasone with daily oral prednisolone and found that the median time to relapse was 44 weeks (SE 4.7) in the dexamethasone group vs. 60 (SE 2.9) in the prednisolone group (p=0.03).
Immunosuppressants were associated with significant side effects.
Comment:The quality of evidence is downgraded by study quality (unclear allocation concealment, high drop-out rate), inconsistency (heterogeneity in treatments and outcomes) and imprecise results (small studies with wide confidence intervals).
Ədəbiyyat
- Gordon PA, Winer JB, Hoogendijk JE et al. Immunosuppressant and immunomodulatory treatment for dermatomyositis and polymyositis. Cochrane Database Syst Rev 2012;8:CD003643.