Mycophenolate mofetil treatment with or without a calcineurin inhibitor in resistant inflammatory myopathy

Hironari Hanaoka, Harunobu Iida, Tomofumi Kiyokawa, Yukiko Takakuwa, Kimito Kawahata

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

To evaluate the efficacy and tolerability of mycophenolate mofetil (MMF) with or without calcineurin inhibitors (CNIs) in patients with inflammatory myopathy taking prednisolone, but refractory to conventional immunosuppressive therapy. The records of patients with inflammatory myopathy who had previously failed treatment with at least one immunosuppressant were retrospectively evaluated. We selected patients treated with MMF and divided them into two groups depending on whether or not there was concomitant use of CNIs. We investigated the efficacy by changes in creatine kinase (CK) levels, forced vital capacity (%FVC), prednisolone dose, and high-resolution computed tomography (HRCT) findings. Interstitial lung disease (ILD) progression was defined by more than 10% decline of %FVC from baseline. We identified 19 patients on MMF treatment. There were seven (36.8%) patients on MMF and CNIs, including five on cyclosporine and two on tacrolimus. At baseline, no significant difference was seen in the prevalence of ILD between patients taking or not taking CNIs (85.7% vs. 75.0%, P = 0.68). Improvement in CK was seen in patients treated with CNIs (P = 0.04) but not in those without (P = 0.39). No significant improvement in %FVC and HRCT findings were found in patients with ILD in either group, and there were no differences in death or ILD progression. The combination of CNIs and MMF might be more effective for decreasing CK levels than MMF alone. Neither treatment arm had a beneficial effect on ILD over a variable observation period.

Original languageEnglish
Pages (from-to)585-590
Number of pages6
JournalClinical Rheumatology
Volume38
Issue number2
DOIs
Publication statusPublished - 2019 Feb 14
Externally publishedYes

Fingerprint

Mycophenolic Acid
Myositis
Interstitial Lung Diseases
Creatine Kinase
Therapeutics
Immunosuppressive Agents
Prednisolone
Disease Progression
Tomography
Calcineurin Inhibitors
Vital Capacity
Tacrolimus
Cyclosporine
Observation

Keywords

  • Dermatomyositis
  • Drug therapy
  • Inflammatory myopathy/CO
  • Interstitial lung disease
  • Mycophenolate mofetil
  • Polymyositis
  • Tacrolimus

ASJC Scopus subject areas

  • Rheumatology

Cite this

Mycophenolate mofetil treatment with or without a calcineurin inhibitor in resistant inflammatory myopathy. / Hanaoka, Hironari; Iida, Harunobu; Kiyokawa, Tomofumi; Takakuwa, Yukiko; Kawahata, Kimito.

In: Clinical Rheumatology, Vol. 38, No. 2, 14.02.2019, p. 585-590.

Research output: Contribution to journalArticle

Hanaoka, Hironari ; Iida, Harunobu ; Kiyokawa, Tomofumi ; Takakuwa, Yukiko ; Kawahata, Kimito. / Mycophenolate mofetil treatment with or without a calcineurin inhibitor in resistant inflammatory myopathy. In: Clinical Rheumatology. 2019 ; Vol. 38, No. 2. pp. 585-590.
@article{69189da9401d4f2f8d52816b3e6a0a47,
title = "Mycophenolate mofetil treatment with or without a calcineurin inhibitor in resistant inflammatory myopathy",
abstract = "To evaluate the efficacy and tolerability of mycophenolate mofetil (MMF) with or without calcineurin inhibitors (CNIs) in patients with inflammatory myopathy taking prednisolone, but refractory to conventional immunosuppressive therapy. The records of patients with inflammatory myopathy who had previously failed treatment with at least one immunosuppressant were retrospectively evaluated. We selected patients treated with MMF and divided them into two groups depending on whether or not there was concomitant use of CNIs. We investigated the efficacy by changes in creatine kinase (CK) levels, forced vital capacity ({\%}FVC), prednisolone dose, and high-resolution computed tomography (HRCT) findings. Interstitial lung disease (ILD) progression was defined by more than 10{\%} decline of {\%}FVC from baseline. We identified 19 patients on MMF treatment. There were seven (36.8{\%}) patients on MMF and CNIs, including five on cyclosporine and two on tacrolimus. At baseline, no significant difference was seen in the prevalence of ILD between patients taking or not taking CNIs (85.7{\%} vs. 75.0{\%}, P = 0.68). Improvement in CK was seen in patients treated with CNIs (P = 0.04) but not in those without (P = 0.39). No significant improvement in {\%}FVC and HRCT findings were found in patients with ILD in either group, and there were no differences in death or ILD progression. The combination of CNIs and MMF might be more effective for decreasing CK levels than MMF alone. Neither treatment arm had a beneficial effect on ILD over a variable observation period.",
keywords = "Dermatomyositis, Drug therapy, Inflammatory myopathy/CO, Interstitial lung disease, Mycophenolate mofetil, Polymyositis, Tacrolimus",
author = "Hironari Hanaoka and Harunobu Iida and Tomofumi Kiyokawa and Yukiko Takakuwa and Kimito Kawahata",
year = "2019",
month = "2",
day = "14",
doi = "10.1007/s10067-018-4294-9",
language = "English",
volume = "38",
pages = "585--590",
journal = "Clinical Rheumatology",
issn = "0770-3198",
publisher = "Springer London",
number = "2",

}

TY - JOUR

T1 - Mycophenolate mofetil treatment with or without a calcineurin inhibitor in resistant inflammatory myopathy

AU - Hanaoka, Hironari

AU - Iida, Harunobu

AU - Kiyokawa, Tomofumi

AU - Takakuwa, Yukiko

AU - Kawahata, Kimito

PY - 2019/2/14

Y1 - 2019/2/14

N2 - To evaluate the efficacy and tolerability of mycophenolate mofetil (MMF) with or without calcineurin inhibitors (CNIs) in patients with inflammatory myopathy taking prednisolone, but refractory to conventional immunosuppressive therapy. The records of patients with inflammatory myopathy who had previously failed treatment with at least one immunosuppressant were retrospectively evaluated. We selected patients treated with MMF and divided them into two groups depending on whether or not there was concomitant use of CNIs. We investigated the efficacy by changes in creatine kinase (CK) levels, forced vital capacity (%FVC), prednisolone dose, and high-resolution computed tomography (HRCT) findings. Interstitial lung disease (ILD) progression was defined by more than 10% decline of %FVC from baseline. We identified 19 patients on MMF treatment. There were seven (36.8%) patients on MMF and CNIs, including five on cyclosporine and two on tacrolimus. At baseline, no significant difference was seen in the prevalence of ILD between patients taking or not taking CNIs (85.7% vs. 75.0%, P = 0.68). Improvement in CK was seen in patients treated with CNIs (P = 0.04) but not in those without (P = 0.39). No significant improvement in %FVC and HRCT findings were found in patients with ILD in either group, and there were no differences in death or ILD progression. The combination of CNIs and MMF might be more effective for decreasing CK levels than MMF alone. Neither treatment arm had a beneficial effect on ILD over a variable observation period.

AB - To evaluate the efficacy and tolerability of mycophenolate mofetil (MMF) with or without calcineurin inhibitors (CNIs) in patients with inflammatory myopathy taking prednisolone, but refractory to conventional immunosuppressive therapy. The records of patients with inflammatory myopathy who had previously failed treatment with at least one immunosuppressant were retrospectively evaluated. We selected patients treated with MMF and divided them into two groups depending on whether or not there was concomitant use of CNIs. We investigated the efficacy by changes in creatine kinase (CK) levels, forced vital capacity (%FVC), prednisolone dose, and high-resolution computed tomography (HRCT) findings. Interstitial lung disease (ILD) progression was defined by more than 10% decline of %FVC from baseline. We identified 19 patients on MMF treatment. There were seven (36.8%) patients on MMF and CNIs, including five on cyclosporine and two on tacrolimus. At baseline, no significant difference was seen in the prevalence of ILD between patients taking or not taking CNIs (85.7% vs. 75.0%, P = 0.68). Improvement in CK was seen in patients treated with CNIs (P = 0.04) but not in those without (P = 0.39). No significant improvement in %FVC and HRCT findings were found in patients with ILD in either group, and there were no differences in death or ILD progression. The combination of CNIs and MMF might be more effective for decreasing CK levels than MMF alone. Neither treatment arm had a beneficial effect on ILD over a variable observation period.

KW - Dermatomyositis

KW - Drug therapy

KW - Inflammatory myopathy/CO

KW - Interstitial lung disease

KW - Mycophenolate mofetil

KW - Polymyositis

KW - Tacrolimus

UR - http://www.scopus.com/inward/record.url?scp=85053483225&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053483225&partnerID=8YFLogxK

U2 - 10.1007/s10067-018-4294-9

DO - 10.1007/s10067-018-4294-9

M3 - Article

VL - 38

SP - 585

EP - 590

JO - Clinical Rheumatology

JF - Clinical Rheumatology

SN - 0770-3198

IS - 2

ER -