Biologic therapy in the idiopathic inflammatory myopathies

  • Thomas Khoo
  • Vidya LimayeEmail author


The idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases resulting from inflammation of muscle and manifesting as weakness, though a range of extra-muscular manifestations are observed. These are often correlated closely with disease subtype and the presence of myositis-specific/myositis-associated antibodies. IIM are notoriously difficult to treat and often refractory to glucocorticoid therapy and synthetic immunosuppressants. Both the innate and adaptive immune systems are implicated in the pathogenesis of IIM. A growing understanding of the key cytokines as well as the cell-mediated and antibody effectors of disease has identified multiple potential targets for biologic therapy. The most widely used of these is B-cell depletion via rituximab though the tumour necrosis factor inhibitors and other biologic therapies used in diseases such as rheumatoid arthritis, systemic lupus erythematosus and multiple sclerosis have also been trialled. This review summarises the literature thus far on biologic therapy in IIM, highlighting both the significant trials that influence current treatment regimens and also the continuing need for further research to inform more effective therapies.


Idiopathic inflammatory myopathies Biologics Rituximab Infliximab Etanercept 


Compliance with ethical standards

Conflict of interest

Thomas Khoo declares that he/she has no conflict of interest. Vidya Limaye declares that he/she has no conflict of interest.


  1. 1.
    Marie I (2012) Morbidity and mortality in adult polymyositis and dermatomyositis. Curr Rheumatol Rep 14(3):275–285. CrossRefPubMedGoogle Scholar
  2. 2.
    Wendling D (2007) Biologics in the treatment of primary inflammatory myositis. Jt Bone Spine 74(4):316–318. CrossRefGoogle Scholar
  3. 3.
    Lundberg IE, Vencovsky J, Alexanderson H (2014) Therapy of myositis: biological and physical. Curr Opin Rheumatol 26(6):704–711. CrossRefPubMedGoogle Scholar
  4. 4.
    Dalakas MC, Hohlfeld R (2003) Polymyositis and dermatomyositis. Lancet 362(9388):971–982. CrossRefPubMedGoogle Scholar
  5. 5.
    Marie I, Hachulla E, Hatron PY, Hellot MF, Levesque H, Devulder B, Courtois H (2001) Polymyositis and dermatomyositis: short term and longterm outcome, and predictive factors of prognosis. J Rheumatol 28(10):2230–2237PubMedGoogle Scholar
  6. 6.
    Pipitone N (2016) Value of MRI in diagnostics and evaluation of myositis. Curr Opin Rheumatol 28(6):625–630. CrossRefPubMedGoogle Scholar
  7. 7.
    Satoh M, Tanaka S, Ceribelli A, Calise SJ, Chan EK (2017) A comprehensive overview on myositis-specific antibodies: new and old biomarkers in idiopathic inflammatory myopathy. Clin Rev Allergy Immunol 52(1):1–19. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Luo YB, Mastaglia FL (2015) Dermatomyositis, polymyositis and immune-mediated necrotising myopathies. Biochim Biophys Acta 1852 4:622–632. CrossRefGoogle Scholar
  9. 9.
    Tieu J, Lundberg IE, Limaye V (2016) Idiopathic inflammatory myositis. Best Pract Res Clin Rheumatol 30(1):149–168. CrossRefPubMedGoogle Scholar
  10. 10.
    Katzap E, Barilla-LaBarca ML, Marder G (2011) Antisynthetase syndrome. Curr Rheumatol Rep 13(3):175–181. CrossRefPubMedGoogle Scholar
  11. 11.
    Ghirardello A, Zampieri S, Tarricone E, Iaccarino L, Bendo R, Briani C, Rondinone R, Sarzi-Puttini P, Todesco S, Doria A (2006) Clinical implications of autoantibody screening in patients with autoimmune myositis. Autoimmunity 39(3):217–221. CrossRefPubMedGoogle Scholar
  12. 12.
    Clark KEN, Isenberg DA (2018) A review of inflammatory idiopathic myopathy focusing on polymyositis. Eur J Neurol 25(1):13–23. CrossRefPubMedGoogle Scholar
  13. 13.
    Gherardi RK (2011) Pathogenic aspects of dermatomyositis, polymyositis and overlap myositis. Presse Med 40(4 Pt 2):e209–218. CrossRefPubMedGoogle Scholar
  14. 14.
    Chahin N, Engel AG (2008) Correlation of muscle biopsy, clinical course, and outcome in PM and sporadic IBM. Neurology 70(6):418–424. CrossRefPubMedGoogle Scholar
  15. 15.
    Greenberg SA (2019) Inclusion body myositis: clinical features and pathogenesis. Nat Rev Rheumatol 15(5):257–272. CrossRefPubMedGoogle Scholar
  16. 16.
    Basharat P, Christopher-Stine L (2015) Immune-mediated necrotizing myopathy: update on diagnosis and management. Curr Rheumatol Rep 17(12):72. CrossRefPubMedGoogle Scholar
  17. 17.
    Greenberg SA (2010) Type 1 interferons and myositis. Arthritis Res Ther 12(Suppl 1):S4. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Franzi S, Salajegheh M, Nazareno R, Greenberg SA (2013) Type 1 interferons inhibit myotube formation independently of upregulation of interferon-stimulated gene 15. PLoS ONE 8(6):e65362. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ladislau L, Suarez-Calvet X, Toquet S, Landon-Cardinal O, Amelin D, Depp M, Rodero MP, Hathazi D, Duffy D, Bondet V, Preusse C, Bienvenu B, Rozenberg F, Roos A, Benjamim CF, Gallardo E, Illa I, Mouly V, Stenzel W, Butler-Browne G, Benveniste O, Allenbach Y (2018) JAK inhibitor improves type I interferon induced damage: proof of concept in dermatomyositis. Brain 141(6):1609–1621. CrossRefPubMedGoogle Scholar
  20. 20.
    Grundtman C, Bruton J, Yamada T, Ostberg T, Pisetsky DS, Harris HE, Andersson U, Lundberg IE, Westerblad H (2010) Effects of HMGB1 on in vitro responses of isolated muscle fibers and functional aspects in skeletal muscles of idiopathic inflammatory myopathies. FASEB J 24(2):570–578. CrossRefPubMedGoogle Scholar
  21. 21.
    Kuru S, Inukai A, Liang Y, Doyu M, Takano A, Sobue G (2000) Tumor necrosis factor-alpha expression in muscles of polymyositis and dermatomyositis. Acta Neuropathol 99(5):585–588CrossRefGoogle Scholar
  22. 22.
    Lundberg I, Ulfgren AK, Nyberg P, Andersson U, Klareskog L (1997) Cytokine production in muscle tissue of patients with idiopathic inflammatory myopathies. Arthritis Rheum 40(5):865–874. CrossRefPubMedGoogle Scholar
  23. 23.
    Efthimiou P (2006) Tumor necrosis factor-alpha in inflammatory myopathies: pathophysiology and therapeutic implications. Semin Arthritis Rheum 36(3):168–172. CrossRefPubMedGoogle Scholar
  24. 24.
    Sultan SM, Ng KP, Edwards JC, Isenberg DA, Cambridge G (2008) Clinical outcome following B cell depletion therapy in eight patients with refractory idiopathic inflammatory myopathy. Clin Exp Rheumatol 26(5):887–893PubMedGoogle Scholar
  25. 25.
    Betteridge Z, McHugh N (2016) Myositis-specific autoantibodies: an important tool to support diagnosis of myositis. J Intern Med 280(1):8–23. CrossRefPubMedGoogle Scholar
  26. 26.
    Greenberg SA, Bradshaw EM, Pinkus JL, Pinkus GS, Burleson T, Due B, Bregoli L, O'Connor KC, Amato AA (2005) Plasma cells in muscle in inclusion body myositis and polymyositis. Neurology 65(11):1782–1787. CrossRefPubMedGoogle Scholar
  27. 27.
    Munoz-Beamud F, Isenberg DA (2013) Rituximab as an effective alternative therapy in refractory idiopathic inflammatory myopathies. Clin Exp Rheumatol 31(6):896–903PubMedGoogle Scholar
  28. 28.
    Levine TD (2005) Rituximab in the treatment of dermatomyositis: an open-label pilot study. Arthritis Rheum 52(2):601–607. CrossRefPubMedGoogle Scholar
  29. 29.
    Limaye V, Hissaria P, Liew CL, Koszyka B (2012) Efficacy of rituximab in refractory antisynthetase syndrome. Intern Med J 42(3):e4–7. CrossRefPubMedGoogle Scholar
  30. 30.
    Noss EH, Hausner-Sypek DL, Weinblatt ME (2006) Rituximab as therapy for refractory polymyositis and dermatomyositis. J Rheumatol 33(5):1021–1026PubMedGoogle Scholar
  31. 31.
    Lopez J, Merino L, Piris L, Herrera FS, Llorente I, Humbria A, Ortiz AM, Velasco T, Garcia-Vicuna R, Castaneda S, Gonzalez Alvaro I, Munoz-Calleja C (2019) Rituximab induces a lasting, non-cumulative remodelling of the B-cell compartment. Clin Exp Rheumatol 37(4):615–622PubMedGoogle Scholar
  32. 32.
    Majmudar S, Hall HA, Zimmermann B (2009) Treatment of adult inflammatory myositis with rituximab: an emerging therapy for refractory patients. J Clin Rheumatol 15(7):338–340. CrossRefPubMedGoogle Scholar
  33. 33.
    Oddis CV, Reed AM, Aggarwal R, Rider LG, Ascherman DP, Levesque MC, Barohn RJ, Feldman BM, Harris-Love MO, Koontz DC, Fertig N, Kelley SS, Pryber SL, Miller FW, Rockette HE, Group RIMS (2013) Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum 65(2):314–324. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    de Visser M (2013) The efficacy of rituximab in refractory myositis: the jury is still out. Arthritis Rheum 65(2):303–306. CrossRefPubMedGoogle Scholar
  35. 35.
    Aggarwal R, Oddis CV (2012) Inclusion body myositis: therapeutic approaches. Degener Neurol Neuromuscul Dis 2:43–52. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Aggarwal R, Bandos A, Reed AM, Ascherman DP, Barohn RJ, Feldman BM, Miller FW, Rider LG, Harris-Love MO, Levesque MC, Group RIMS, Oddis CV (2014) Predictors of clinical improvement in rituximab-treated refractory adult and juvenile dermatomyositis and adult polymyositis. Arthritis Rheumatol 66(3):740–749. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Leclair V, Galindo-Feria AS, Dastmalchi M, Holmqvist M, Lundberg IE (2019) Efficacy and safety of rituximab in anti-synthetase antibody positive and negative subjects with idiopathic inflammatory myopathy: a registry-based study. Rheumatology (Oxford) 58(7):1214–1220. CrossRefGoogle Scholar
  38. 38.
    Barsotti S, Cioffi E, Tripoli A, Tavoni A, D'Ascanio A, Mosca M, Neri R (2018) The use of rituximab in idiopathic inflammatory myopathies: description of a monocentric cohort and review of the literature. Reumatismo 70(2):78–84. CrossRefPubMedGoogle Scholar
  39. 39.
    Mahler EA, Blom M, Voermans NC, van Engelen BG, van Riel PL, Vonk MC (2011) Rituximab treatment in patients with refractory inflammatory myopathies. Rheumatology (Oxford) 50(12):2206–2213. CrossRefGoogle Scholar
  40. 40.
    Brulhart L, Waldburger JM, Gabay C (2006) Rituximab in the treatment of antisynthetase syndrome. Ann Rheum Dis 65(7):974–975. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Andersson H, Sem M, Lund MB, Aalokken TM, Gunther A, Walle-Hansen R, Garen T, Molberg O (2015) Long-term experience with rituximab in anti-synthetase syndrome-related interstitial lung disease. Rheumatology (Oxford) 54(8):1420–1428. CrossRefGoogle Scholar
  42. 42.
    Marie I, Dominique S, Janvresse A, Levesque H, Menard JF (2012) Rituximab therapy for refractory interstitial lung disease related to antisynthetase syndrome. Respir Med 106(4):581–587. CrossRefPubMedGoogle Scholar
  43. 43.
    Zappa MC, Trequattrini T, Mattioli F, Rivitti R, Vigliarolo R, Marcoccia A, D'Arcangelo G (2011) Rituximab treatment in a case of antisynthetase syndrome with severe interstitial lung disease and acute respiratory failure. Multidiscip Respir Med 6(3):183–188. CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Torres C, Belmonte R, Carmona L, Gomez-Reino FJ, Galindo M, Ramos B, Cabello A, Carreira PE (2006) Survival, mortality and causes of death in inflammatory myopathies. Autoimmunity 39(3):205–215. CrossRefPubMedGoogle Scholar
  45. 45.
    Saunders P, Tsipouri V, Keir GJ, Ashby D, Flather MD, Parfrey H, Babalis D, Renzoni EA, Denton CP, Wells AU, Maher TM (2017) Rituximab versus cyclophosphamide for the treatment of connective tissue disease-associated interstitial lung disease (RECITAL): study protocol for a randomised controlled trial. Trials 18(1):275. CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    So H, Wong VTL, Lao VWN, Pang HT, Yip RML (2018) Rituximab for refractory rapidly progressive interstitial lung disease related to anti-MDA5 antibody-positive amyopathic dermatomyositis. Clin Rheumatol 37(7):1983–1989. CrossRefPubMedGoogle Scholar
  47. 47.
    Tokunaga K, Hagino N (2017) Dermatomyositis with rapidly progressive interstitial lung disease treated with rituximab: a report of 3 cases in Japan. Intern Med 56(11):1399–1403. CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Chung L, Genovese MC, Fiorentino DF (2007) A pilot trial of rituximab in the treatment of patients with dermatomyositis. Arch Dermatol 143(6):763–767. CrossRefPubMedGoogle Scholar
  49. 49.
    Dinh HV, McCormack C, Hall S, Prince HM (2007) Rituximab for the treatment of the skin manifestations of dermatomyositis: a report of 3 cases. J Am Acad Dermatol 56(1):148–153. CrossRefPubMedGoogle Scholar
  50. 50.
    Danko K, Ponyi A, Constantin T, Borgulya G, Szegedi G (2004) Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features: a longitudinal study of 162 cases. Medicine (Baltimore) 83(1):35–42. CrossRefGoogle Scholar
  51. 51.
    Touma Z, Arayssi T, Kibbi L, Masri AF (2008) Successful treatment of cardiac involvement in dermatomyositis with rituximab. Jt Bone Spine 75(3):334–337. CrossRefGoogle Scholar
  52. 52.
    Landon-Cardinal O, Allenbach Y, Soulages A, Rigolet A, Hervier B, Champtiaux N, Monzani Q, Sole G, Benveniste O (2019) Rituximab in the treatment of refractory anti-HMGCR immune-mediated necrotizing myopathy. J Rheumatol 46(6):623–627. CrossRefPubMedGoogle Scholar
  53. 53.
    Ashton C, Junckerstorff R, Bundell C, Hollingsworth P, Needham M (2016) Treatment and outcomes in necrotising autoimmune myopathy: an Australian perspective. Neuromuscul Disord 26(11):734–740. CrossRefPubMedGoogle Scholar
  54. 54.
    Valiyil R, Casciola-Rosen L, Hong G, Mammen A, Christopher-Stine L (2010) Rituximab therapy for myopathy associated with anti-signal recognition particle antibodies: a case series. Arthritis Care Res (Hoboken) 62(9):1328–1334. CrossRefGoogle Scholar
  55. 55.
    Vordenbaumen S, Neuen-Jacob E, Richter J, Schneider M (2010) Inclusion body myositis in a patient with long standing rheumatoid arthritis treated with anti-TNFalpha and rituximab. Clin Rheumatol 29(5):555–558. CrossRefPubMedGoogle Scholar
  56. 56.
    Rath E, Zwerina J, Oppl B, Nell-Duxneuner V (2015) Efficacy and safety of rituximab in rheumatic diseases. Wien Med Wochenschr 165(1–2):28–35. CrossRefPubMedGoogle Scholar
  57. 57.
    Lutt JR, Pisculli ML, Weinblatt ME, Deodhar A, Winthrop KL (2008) Severe nontuberculous mycobacterial infection in 2 patients receiving rituximab for refractory myositis. J Rheumatol 35(8):1683–1685PubMedGoogle Scholar
  58. 58.
    Couderc M, Gottenberg JE, Mariette X, Hachulla E, Sibilia J, Fain O, Hot A, Dougados M, Euller-Ziegler L, Bourgeois P, Larroche C, Tournadre A, Amoura Z, Mazieres B, Arlet P, De Bandt M, Schaeverbeke T, Soubrier M (2011) Efficacy and safety of rituximab in the treatment of refractory inflammatory myopathies in adults: results from the AIR registry. Rheumatology (Oxford) 50(12):2283–2289. CrossRefGoogle Scholar
  59. 59.
    Belhassen-Garcia M, Rabano-Gutierrez A, Velasco-Tirado V, Romero-Alegria A, Perez-Garcia ML, Martin-Oterino JA (2015) Atypical progressive multifocal leukoencephalopathy in a patient with antisynthetase syndrome. Intern Med 54(5):519–524. CrossRefPubMedGoogle Scholar
  60. 60.
    Marie I, Guegan-Massardier E, Levesque H (2011) Progressive multifocal leukoencephalopathy in refractory polymyositis treated with rituximab. Eur J Intern Med 22(3):e13–14. CrossRefPubMedGoogle Scholar
  61. 61.
    Schiffenbauer A, Garg M, Castro C, Pokrovnichka A, Joe G, Shrader J, Cabalar IV, Faghihi-Kashani S, Harris-Love MO, Plotz PH, Miller FW, Gourley M (2018) A randomized, double-blind, placebo-controlled trial of infliximab in refractory polymyositis and dermatomyositis. Semin Arthritis Rheum 47(6):858–864. CrossRefPubMedGoogle Scholar
  62. 62.
    Chen D, Wang XB, Zhou Y, Zhu XC (2013) Efficacy of infliximab in the treatment for dermatomyositis with acute interstitial pneumonia: a study of fourteen cases and literature review. Rheumatol Int 33(10):2455–2458. CrossRefPubMedGoogle Scholar
  63. 63.
    Hengstman GJ, De Bleecker JL, Feist E, Vissing J, Denton CP, Manoussakis MN, Slott Jensen H, van Engelen BG, van den Hoogen FH (2008) Open-label trial of anti-TNF-alpha in dermato- and polymyositis treated concomitantly with methotrexate. Eur Neurol 59(3–4):159–163. CrossRefPubMedGoogle Scholar
  64. 64.
    Dastmalchi M, Grundtman C, Alexanderson H, Mavragani CP, Einarsdottir H, Helmers SB, Elvin K, Crow MK, Nennesmo I, Lundberg IE (2008) A high incidence of disease flares in an open pilot study of infliximab in patients with refractory inflammatory myopathies. Ann Rheum Dis 67(12):1670–1677. CrossRefPubMedGoogle Scholar
  65. 65.
    Muscle Study G (2011) A randomized, pilot trial of etanercept in dermatomyositis. Ann Neurol 70(3):427–436. CrossRefGoogle Scholar
  66. 66.
    Iannone F, Scioscia C, Falappone PCF, Covelli M, Lapadula G (2006) Use of etanercept in the treatment of dermatomyositis: a case series. J Rheumatol 33(9):1802–1804PubMedGoogle Scholar
  67. 67.
    Efthimiou P, Schwartzman S, Kagen LJ (2006) Possible role for tumour necrosis factor inhibitors in the treatment of resistant dermatomyositis and polymyositis: a retrospective study of eight patients. Ann Rheum Dis 65(9):1233–1236. CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    da Silva TC, Zon Pretti F, Shinjo SK (2013) Adalimumab in anti-synthetase syndrome. Jt Bone Spine 80(4):432. CrossRefGoogle Scholar
  69. 69.
    Park JK, Yoo HG, Ahn DS, Jeon HS, Yoo WH (2012) Successful treatment for conventional treatment-resistant dermatomyositis-associated interstitial lung disease with adalimumab. Rheumatol Int 32(11):3587–3590. CrossRefPubMedGoogle Scholar
  70. 70.
    Wronski J, Fiedor P (2019) The safety profile of tumor necrosis factor inhibitors in ankylosing spondylitis: are TNF inhibitors safer than we thought? J Clin Pharmacol 59(4):445–462. CrossRefPubMedGoogle Scholar
  71. 71.
    Dold S, Justiniano ME, Marquez J, Espinoza LR (2007) Treatment of early and refractory dermatomyositis with infliximab: a report of two cases. Clin Rheumatol 26(7):1186–1188. CrossRefPubMedGoogle Scholar
  72. 72.
    Brunasso AM, Aberer W, Massone C (2014) New onset of dermatomyositis/polymyositis during anti-TNF-alpha therapies: a systematic literature review. Sci World J 2014:179180. CrossRefGoogle Scholar
  73. 73.
    Maundrell A, Proudman S, Limaye V (2019) Prevalence of other connective tissue diseases in idiopathic inflammatory myopathies. Rheumatol Int. CrossRefPubMedGoogle Scholar
  74. 74.
    Ishikawa Y, Yukawa N, Kawabata D, Ohmura K, Fujii T, Usui T, Mimori T (2011) A case of antisynthetase syndrome in a rheumatoid arthritis patient with anti-PL-12 antibody following treatment with etanercept. Clin Rheumatol 30(3):429–432. CrossRefPubMedGoogle Scholar
  75. 75.
    Allenbach Y, Guiguet M, Rigolet A, Marie I, Hachulla E, Drouot L, Jouen F, Jacquot S, Mariampillai K, Musset L, Grenier P, Devilliers H, Hij A, Boyer O, Herson S, Benveniste O (2015) Efficacy of Rituximab in refractory inflammatory myopathies associated with anti-synthetase auto-antibodies: an open-label phase II trial. PLoS ONE 10(11):e0133702. CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Sem M, Molberg O, Lund MB, Gran JT (2009) Rituximab treatment of the anti-synthetase syndrome: a retrospective case series. Rheumatology (Oxford) 48(8):968–971. CrossRefGoogle Scholar
  77. 77.
    Huber AM (2018) Update on the clinical management of juvenile dermatomyositis. Expert Rev Clin Immunol 14(12):1021–1028. CrossRefPubMedGoogle Scholar
  78. 78.
    Bader-Meunier B, Decaluwe H, Barnerias C, Gherardi R, Quartier P, Faye A, Guigonis V, Pagnier A, Brochard K, Sibilia J, Gottenberg JE, Bodemer C, Club Rhumatismes et I (2011) Safety and efficacy of rituximab in severe juvenile dermatomyositis: results from 9 patients from the French autoimmunity and rituximab registry. J Rheumatol 38(7):1436–1440. CrossRefPubMedGoogle Scholar
  79. 79.
    Riley P, McCann LJ, Maillard SM, Woo P, Murray KJ, Pilkington CA (2008) Effectiveness of infliximab in the treatment of refractory juvenile dermatomyositis with calcinosis. Rheumatology (Oxford) 47(6):877–880. CrossRefGoogle Scholar
  80. 80.
    Rouster-Stevens KA, Ferguson L, Morgan G, Huang CC, Pachman LM (2014) Pilot study of etanercept in patients with refractory juvenile dermatomyositis. Arthritis Care Res (Hoboken) 66(5):783–787. CrossRefGoogle Scholar
  81. 81.
    Lorenzetti R, Janowska I, Smulski CR, Frede N, Henneberger N, Walter L, Schleyer MT, Huppe JM, Staniek J, Salzer U, Venhoff A, Troilo A, Voll RE, Venhoff N, Thiel J, Rizzi M (2019) Abatacept modulates CD80 and CD86 expression and memory formation in human B-cells. J Autoimmun 101:145–152. CrossRefPubMedGoogle Scholar
  82. 82.
    Tjarnlund A, Tang Q, Wick C, Dastmalchi M, Mann H, Tomasova Studynkova J, Chura R, Gullick NJ, Salerno R, Ronnelid J, Alexanderson H, Lindroos E, Aggarwal R, Gordon P, Vencovsky J, Lundberg IE (2018) Abatacept in the treatment of adult dermatomyositis and polymyositis: a randomised, phase IIb treatment delayed-start trial. Ann Rheum Dis 77(1):55–62. CrossRefPubMedGoogle Scholar
  83. 83.
    Kerola AM, Kauppi MJ (2015) Abatacept as a successful therapy for myositis-a case-based review. Clin Rheumatol 34(3):609–612. CrossRefPubMedGoogle Scholar
  84. 84.
    Musuruana JL, Cavallasca JA (2011) Abatacept for treatment of refractory polymyositis. Jt Bone Spine 78(4):431–432. CrossRefGoogle Scholar
  85. 85.
    Klotz L, Meuth SG, Wiendl H (2012) Immune mechanisms of new therapeutic strategies in multiple sclerosis-A focus on alemtuzumab. Clin Immunol 142(1):25–30. CrossRefPubMedGoogle Scholar
  86. 86.
    Coles AJ, Cox A, Le Page E, Jones J, Trip SA, Deans J, Seaman S, Miller DH, Hale G, Waldmann H, Compston DA (2006) The window of therapeutic opportunity in multiple sclerosis: evidence from monoclonal antibody therapy. J Neurol 253(1):98–108. CrossRefPubMedGoogle Scholar
  87. 87.
    Ruck T, Bittner S, Kuhlmann T, Wiendl H, Meuth SG (2015) Long-term efficacy of alemtuzumab in polymyositis. Rheumatology (Oxford) 54(3):560–562. CrossRefGoogle Scholar
  88. 88.
    Thompson B, Corris P, Miller JA, Cooper RG, Halsey JP, Isaacs JD (2008) Alemtuzumab (Campath-1H) for treatment of refractory polymyositis. J Rheumatol 35(10):2080–2082PubMedGoogle Scholar
  89. 89.
    Dalakas MC, Rakocevic G, Schmidt J, Salajegheh M, McElroy B, Harris-Love MO, Shrader JA, Levy EW, Dambrosia J, Kampen RL, Bruno DA, Kirk AD (2009) Effect of alemtuzumab (CAMPATH 1-H) in patients with inclusion-body myositis. Brain 132(Pt 6):1536–1544. CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Greenberg SA (2010) Comment on alemtuzumab and inclusion body myositis. Brain 133(Pt 5):e135. (author reply e136) CrossRefPubMedGoogle Scholar
  91. 91.
    Pipitone N, Salvarani C (2013) CD25 blockade for refractory polymyositis. Clin Exp Rheumatol 31(3):474PubMedGoogle Scholar
  92. 92.
    Zou J, Li T, Huang X, Chen S, Guo Q, Bao C (2014) Basiliximab may improve the survival rate of rapidly progressive interstitial pneumonia in patients with clinically amyopathic dermatomyositis with anti-MDA5 antibody. Ann Rheum Dis 73(8):1591–1593. CrossRefPubMedGoogle Scholar
  93. 93.
    Mathian A, Hie M, Cohen-Aubart F, Amoura Z (2015) Targeting interferons in systemic lupus erythematosus: current and future prospects. Drugs 75(8):835–846. CrossRefPubMedGoogle Scholar
  94. 94.
    Guo X, Higgs BW, Rebelatto M, Zhu W, Greth W, Yao Y, Roskos LK, White WI (2014) Suppression of soluble T cell-associated proteins by an anti-interferon-alpha monoclonal antibody in adult patients with dermatomyositis or polymyositis. Rheumatology (Oxford) 53(4):686–695. CrossRefGoogle Scholar
  95. 95.
    Dhillon S (2014) Intravenous tocilizumab: a review of its use in adults with rheumatoid arthritis. BioDrugs 28(1):75–106. CrossRefPubMedGoogle Scholar
  96. 96.
    Beaumel A, Muis-Pistor O, Tebib JG, Coury F (2016) Antisynthetase syndrome treated with tocilizumab. Jt Bone Spine 83(3):361–362. CrossRefGoogle Scholar
  97. 97.
    Murphy SM, Lilleker JB, Helliwell P, Chinoy H (2016) The successful use of tocilizumab as third-line biologic therapy in a case of refractory anti-synthetase syndrome. Rheumatology (Oxford) 55(12):2277–2278. CrossRefGoogle Scholar
  98. 98.
    Kondo M, Murakawa Y, Matsumura T, Matsumoto O, Taira M, Moriyama M, Sumita Y, Yamaguchi S (2014) A case of overlap syndrome successfully treated with tocilizumab: a hopeful treatment strategy for refractory dermatomyositis? Rheumatology (Oxford) 53(10):1907–1908. CrossRefGoogle Scholar
  99. 99.
    Narazaki M, Hagihara K, Shima Y, Ogata A, Kishimoto T, Tanaka T (2011) Therapeutic effect of tocilizumab on two patients with polymyositis. Rheumatology (Oxford) 50(7):1344–1346. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Central Adelaide Local Health NetworkAdelaideAustralia
  2. 2.Rheumatology UnitRoyal Adelaide HospitalAdelaideAustralia
  3. 3.Discipline of Medicine, School of MedicineUniversity of AdelaideAdelaideAustralia

Personalised recommendations