Complete remission and relapse in the treatment of idiopathic inflammatory myopathies: a retrospective cohort study
Naoki Kimura, Manami Nomura, Ryoichi Hanazawa, Akihiro Hirakawa, Mari Kihara, Hirokazu Sasaki, Natsuka Umezawa, Shinsuke YasudaAbstract
Objectives
To investigate the achievement of complete remission (CR) and the management for relapsed cases in the treatment of idiopathic inflammatory myopathies (IIM).
Methods
A total of 132 patients were retrospectively analysed. CR was defined as no evidence of disease activity in all involved organs for a continuous period of six months. Relapse was defined as a dose increase of glucocorticoid (GC) more than 50% and an increase in prednisolone (PSL) equivalent to more than 0.4 mg/kg/day. Clinical data were collected by electrical chart review.
Results
Eighty-eight (66.7%) patients achieved CR with an initial treatment. Forty-three patients experienced at least one relapse. Anti-ARS antibody was positively and achieving CR was negatively associated with relapse (HR 3.02 and OR 0.17, respectively). Re-induction therapies were classified into three groups: high-dose GC plus one immunosuppressant (IS)/biologics (H+1IS, n=12), moderate-dose GC plus two IS/biologics (M+2IS, n=12), and moderate-dose GC plus one IS/biologics (M+1IS, n=19). The frequency of second relapse was least in M+2IS regimen. Concomitant use of two IS/biologics did not increase the incidence of severe adverse events.
Conclusions
CR was achieved in two-thirds of IIM patients. Achieving CR was protective for relapse. Combination therapy with two IS/biologics might be preferable in relapsed cases.