Abstract
Dermatomyositis (DM) and polymyositis (PM) are often refractory to conventional therapy with corticosteroids sometimes combined with immune-suppressing agents and can lead to severe disability if these treatments are unsuccessful. In this prospective, open, non-randomized study, we examined the efficacy of tacrolimus (FK506), an immunosuppressant, in nine patients with DM (n = 5) or PM (n = 4) who did not respond to previous therapy. Outcomes included compound muscle strength, ambulatory status, and serum creatine kinase activity measured at intervals after starting tacrolimus. At 6 months after the introduction of tacrolimus, all five patients with DM and three patients with PM showed clinical improvements. Patients with a disease duration of <4 years and those with trough level of tacrolimus >5 ng/ml tended to have better outcomes than those with longer disease duration or lower trough levels. There were no side effects other than moderate hypertension and aggravation of diabetes mellitus. Tacrolimus was beneficial in the majority of patients with PM or DM refractory to corticosteroid therapy. It was also effective in four patients who were previously treated with other immunosuppressants or intravenous immunoglobulin combined with corticosteroids. These results warrant further studies as to the efficacy of tacrolimus compared to other immunosuppressing agents.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Matsubara S, Sawa Y, Takamori M et al (1994) Pulsed intravenous methylprednisolone combined with oral steroids as the initial treatment of inflammatory myopathies. J Neurol Neurosurg Psychiatry 57:1008
Bonner IM, van der Meulen MF, de Visser M et al (2006) Long-term outcome in polymyositis and dermatomyositis. Ann Rheum Dis 65:1456–1461
Wiederrecht G, Lam E, Hung S et al (1993) The mechanism of action of FK-506 and cyclosporin A. Ann N Y Acad Sci 696:9–19
Rusnak F, Mertz P (2000) Calcineurin: form and function. Physiol Rev 80:1483–1521
Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (first of two parts). N Engl J Med 292:344–347
Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (second of two parts). N Engl J Med 292:403–407
Dalakas MC, Koffman B, Fujii M et al (2001) A controlled study of intravenous immunoglobulin combined with prednisone in the treatment of IBM. Neurology 563:323–327
Brooke MH, Griggs RC, Mendell JR et al (1981) Clinical trial in Duchenne dystrophy. I. The design of the protocol. Muscle Nerve 4:186–197
Oddis CV, Sciurba FC, Elmagd KA et al (1999) Tacrolimus in refractory polymyositis with interstitial lung disease. Lancet 353:1762–1763
Couriel DR, Beguelin GZ, Giralt S et al (2002) Chronic graft-versus-host disease manifesting as polymyositis: an uncommon presentation. Bone Marrow Transplant 30:543–546
Joki H, Yamaguchi S, Segawa F, Kuroiwa Y (2005) Effectiveness of tacrolimus in a case of polymyositis. Rinsho Shinkeigaku 45:121–124 (in Japanese)
Mitsui T, Kuroda Y, Kunishige M, Matsumoto T (2005) Successful treatment with tacrolimus in a case of refractory dermatomyositis. Intern Med 44:1197–1199
Ochi S, Nanki T, Takada K et al (2005) Favorable outcomes with tacrolimus in two patients with refractory interstitial lung disease associated with polymyositis/dermatomyositis. Clin Exp Rheumatol 23:707–710
Takada K, Nagasaka K, Miyasaka N (2005) Polymyositis/dermatomyositis and interstitial lung disease: a new therapeutic approach with T-cell-specific immunosuppressants. Autoimmunity 38:383–392
Wilkes MR, Sereika SM, Fertig N, Lucas MR, Oddis CV (2005) Treatment of antisynthetase-associated interstitial lung disease with tacrolimus. Arthritis Rheum 52:2439–2446
Guglielmi S, Merz TM, Gugger M et al (2008) Acute respiratory distress syndrome secondary to antisynthetase syndrome is reversible with tacrolimus. Eur Respir J 31:213–217
Fierlbeck I, Hartmann M (2009) 57-year old female with persistent bilateral oedema of the eyelids. Paraneoplastic dermatomyositis. J Dtsch Dermatol Ges 7:639–640 (in German)
Ando M, Miyazaki E, Yamasue M et al (2010) Successful treatment with tacrolimus of progressive interstitial pneumonia associated with amyopathic dermatomyositis refractory to cyclosporine. Clin Rheumatol 29:443–445
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOCX 28 kb)
Supplementary table 1
Grading of muscle power used in the present study in comparison with that used by Brooke et al. [8] (PPTX 58 kb)
Rights and permissions
About this article
Cite this article
Matsubara, S., Kondo, K., Sugaya, K. et al. Effects of tacrolimus on dermatomyositis and polymyositis: a prospective, open, non-randomized study of nine patients and a review of the literature. Clin Rheumatol 31, 1493–1498 (2012). https://doi.org/10.1007/s10067-012-2044-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-012-2044-y