Dataset Information

Cutaneous improvement in refractory adult and juvenile dermatomyositis after treatment with rituximab.

ABSTRACT:

Objective

The aim was to assess the efficacy of rituximab for the cutaneous manifestations of adult DM and JDM.

Methods

Patients with refractory adult DM (n = 72) and JDM (n = 48) were treated with rituximab in a randomized placebo-phase-controlled trial [either rituximab early drug (week 0/1) or rituximab late arms (week 8/9), such that all subjects received study drug]. Stable concomitant therapy was allowed. Cutaneous disease activity was assessed using the Myositis Disease Activity Assessment Tool, which grades cutaneous disease activity on a visual analog scale. A myositis damage assessment tool, termed the Myositis Damage Index, was used to assess cutaneous damage. Improvement post-rituximab was evaluated in individual rashes as well as in cutaneous disease activity and damage scores. The ?² test, Student's paired t-test and Wilcoxon test were used for analysis.

Results

There were significant improvements in cutaneous disease activity from baseline to the end of the trial after rituximab administration in both adult DM and JDM subsets. The cutaneous visual analog scale activity improved in adult DM (3.22-1.72, P = 0.0002) and JDM (3.26-1.56, P <0.0001), with erythroderma, erythematous rashes without secondary changes of ulceration or necrosis, heliotrope, Gottron sign and papules improving most significantly. Adult DM subjects receiving rituximab earlier in the trial demonstrated a trend for faster cutaneous response (20% relative improvement from baseline) compared with those receiving B cell depletion later (P = 0.052).

Conclusion

Refractory skin rashes in adult DM and JDM showed improvement after the addition of rituximab to the standard therapy in a clinical trial.

SUBMITTER: Aggarwal R

PROVIDER: S-EPMC5854037 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

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Publications

Cutaneous improvement in refractory adult and juvenile dermatomyositis after treatment with rituximab.

Aggarwal Rohit R Loganathan Priyadarshini P Koontz Diane D Qi Zengbiao Z Reed Ann M AM Oddis Chester V CV

Rheumatology (Oxford, England) 20161111 2

<h4>Objective</h4>The aim was to assess the efficacy of rituximab for the cutaneous manifestations of adult DM and JDM.<h4>Methods</h4>Patients with refractory adult DM (n = 72) and JDM (n = 48) were treated with rituximab in a randomized placebo-phase-controlled trial [either rituximab early drug (week 0/1) or rituximab late arms (week 8/9), such that all subjects received study drug]. Stable concomitant therapy was allowed. Cutaneous disease activity was assessed using the Myositis Disease Act ...[more]

PMID: 27837048

Similar Datasets

Project description:ObjectiveTo identify the clinical and laboratory predictors of clinical improvement in a cohort of myositis patients treated with rituximab.MethodsWe analyzed data for 195 patients with myositis (75 with adult polymyositis [PM], 72 with adult dermatomyositis [DM], and 48 with juvenile DM) in the Rituximab in Myositis trial. Clinical improvement was defined as 20% improvement in at least 3 of the following 6 core set measures of disease activity: physician's and patient's/parent's global assessment of disease activity, manual muscle testing, physical function, muscle enzymes, and extramuscular disease activity. We analyzed the association of the following baseline variables with improvement: myositis clinical subgroup, demographics, myositis damage, clinical and laboratory parameters, core set measures, rituximab treatment, and myositis autoantibodies (antisynthetase, anti-Mi-2, anti-signal recognition particle, anti-transcription intermediary factor 1γ [TIF-1γ], anti-MJ, other autoantibodies, and no autoantibodies). All measures were univariately assessed for association with improvement using time-to-event analyses. A multivariable time-dependent proportional hazards model was used to evaluate the association of individual predictive factors with improvement.ResultsIn the final multivariable model, the presence of an antisynthetase, primarily anti-Jo-1 (hazard ratio [HR] 3.08, P < 0.01), anti-Mi-2 (HR 2.5, P < 0.01), or other autoantibody (HR 1.4, P = 0.14) predicted a shorter time to improvement compared to the absence of autoantibodies. A lower physician's global assessment of damage (HR 2.32, P = 0.02) and juvenile DM (versus adult myositis) (HR 2.45, P = 0.01) also predicted improvement. Unlike autoantibody status, the predictive effect of physician's global assessment of damage and juvenile DM diminished by week 20. Rituximab treatment did not affect these associations.ConclusionOur findings indicate that the presence of antisynthetase and anti-Mi-2 autoantibodies, juvenile DM subset, and lower disease damage strongly predict clinical improvement in patients with refractory myositis.

Dataset Information

Cutaneous improvement in refractory adult and juvenile dermatomyositis after treatment with rituximab.

Objective

Methods

Results

Conclusion

Publications

Cutaneous improvement in refractory adult and juvenile dermatomyositis after treatment with rituximab.

Similar Datasets

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