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The following is a summary of “Tacrolimus as first line therapy in a U.S. cohort of idiopathic inflammatory myopathies related interstitial lung disease,” published in the February 2025 issue of Rheumatology by Harris et al.
Calcineurin inhibitors treat idiopathic inflammatory myopathies associated with interstitial lung disease (IIM-ILD) in Asia but are rarely used in the U.S. This study evaluates tacrolimus (TAC) as first-line (1L) therapy in a U.S. cohort.
Researchers conducted a retrospective study to evaluate TAC as first-line (1L) immunosuppressive therapy in a U.S. IIM-ILD cohort.
They conducted a prospective, single-center cohort study evaluating FVCabs changes in participants with IIM-ILD after 12 months of mycophenolate mofetil (MMF), azathioprine (AZA), or TAC treatment. They included participants naïve to immunosuppressants except glucocorticoids and/or IVIG. Treatment choice was at the primary clinician’s discretion. Outcomes included transplant-free survival, prednisone use, and supplemental oxygen use at 12 months.
The results showed 31 participants were included. The TAC group was younger and had a shorter disease duration. All patients with MDA5 received TAC. After 12 months, FVCabsabs remained unchanged in the MMF/AZA group (2.4L [95% CI 2.0, 3.2] vs. 2.3L [95% CI 2.0, 2.8]) but improved in the TAC group (2.5L [95% CI 2.0, 3.0] vs 1.9L [95% CI 1.0, 2.6]). Transplant-free survival was 100% in both groups. All patients with MMF/AZA remained on oxygen, while 4/5 patients with TAC no longer required it.
Investigators found TAC effective as a first-line (1L) agent in a small, non-randomized U.S. IIM-ILD cohort enriched for MDA5+ participants. They suggested further research to compare calcineurin inhibitors with MMF/AZA in the U.S. population.
Source: academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keaf063/7997279
