Intensive induction therapy combining tofacitinib, rituximab and plasma exchange in severe anti-melanoma differentiation-associatedprotein-5 antibody-positive dermatomyositis
Authors' conclusion
IIT significantly improved the survival of patients with severe anti-MDA5 Ab-positive RP-ILD.
Study context
- Population
- Patients with anti-MDA5 Ab-positive dermatomyositis (DM) at one institution, 2014–2021
- Participants
- 33 patients
- Exposure
- Intensive induction therapy (triple therapy with higher-dose methylprednisolone, plasma exchange (PE), rituximab (RTX) and tofacitinib) vs prior triple therapy with RTX, PE or IV immunoglobulin
- Intensive induction therapy (IIT)n = 8
- Triple therapy with RTX, PE, or intravenous immunoglobulinn = 12reference
- Outcome
- Survival (Kaplan-Meier) and adverse events of IIT; poor prognostic factors
Methodological detailssingle-centre, principal component analysis, Kaplan-Meier survival analysis
- Single-centre
- Principal component analysis
- Kaplan-Meier survival analysis
Main finding
As reported in the abstract
Survival
| Group | Value | Deaths of 12 rapidly progressive interstitial lung disease (RP-ILD) cases, median time to death | Mean ferritin (ng/mL) | Deaths of 8 | Mean ferritin |
|---|---|---|---|---|---|
| Pre-IIT | 8 events | 2.5 months | 2,342 | ||
| IIT | 2 events | 2 | 3,558 |
Value
Pre-IIT8 events
IIT2 events
Deaths of 12 rapidly progressive interstitial lung disease (RP-ILD) cases, median time to death
Pre-IIT2.5 months
IIT— not stated in the abstract
Mean ferritin (ng/mL)
Pre-IIT2,342
IIT— not stated in the abstract
Deaths of 8
Pre-IIT— not stated in the abstract
IIT2
Mean ferritin
Pre-IIT— not stated in the abstract
IIT3,558
Observational data: associations, not effects.
Further findings
- Principal component analysis (PCA) revealed distinct clusters for prognosis; age and serum ferritin were leading predictors
Safety
- Several IIT-related adverse events, including viral and fungal infections and cytopenia
Original publication
Intensive induction therapy combining tofacitinib, rituximab and plasma exchange in severe anti-melanoma differentiation-associatedprotein-5 antibody-positive dermatomyositis. Clin Exp Rheumatol. Published 21 October 2022. doi:10.
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