The following is a summary of “Long-Term Prognosis of Antimelanoma Differentiation–Associated Gene 5–Positive Dermatomyositis With Interstitial Lung Disease,” published in the November 2023 issue of Rheumatology by Sasai et al. 

In patients with anti-melanoma differentiation–associated gene 5 (anti-MDA5)–positive dermatomyositis and interstitial lung disease (DM-ILD), rapid progression and a bleak prognosis have been observed. A prior study highlighted the efficacy of a combination therapy, including high-dose glucocorticoids (GCs), calcineurin inhibitors (CNIs), and intravenous cyclophosphamide (IV CYC).

Researchers performed a retrospective study to evaluate the long-term outcomes and effects of induction therapy on remission maintenance in patients with anti-MDA5+ DM-ILD.

All participants from the previous trial were followed for over 5 years. Also, the study included 73 more patients with anti-MDA5–positive DM-ILD. Of the 68 patients who achieved remission and survived for over 6 months, they were categorized into two groups based on their initial treatment: (1) group T (n = 56) received triple combination therapy (GCs, CNIs, and IV CYC), and (2) group C (n = 12) received monotherapy/dual therapy. They compared the rates of recurrence and withdrawal of immunosuppressive agents between the two groups.

At 5 years, the OS and RFS rates were 100% for participants in the previous trial. The 5-year cumulative withdrawal rates for CNIs and GCs were 70% and 53%, respectively. In the comprehensive analysis, group T showed higher recurrence-free rates than group C (90% vs. 56%; P < 0.05). At 10 years, the drug-withdrawal rates for CNIs and GCs in group T were also higher than in group C (79% vs. 0% and 43% vs. 0%, respectively; P < 0.05). 

The study found that triple combination therapy in the induction phase reduces recurrence risk and facilitates drug withdrawal in anti-MDA5+ DM-ILD. 

Source: jrheum.org/content/50/11/1454