ArticleImmunity, inflammation and disease2025
Tacrolimus Trough Concentration-Escalating Bipartite Therapy (Glucocorticoids Combined With Tacrolimus) for Refractory MDA5 Antibody-Positive Clinically Amyopathic Dermatomyositis With Rapidly Progressive Interstitial Pneumonia.
Article in Immunity, inflammation and disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
objectiveThis study aimed to determine the outcomes of patients that have refractory anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonia treated with tacrolimus trough concentration-escalating bipartite therapy (glucocorticoids combined with tacrolimus).
methodsWe retrospectively enrolled 19 patients that had refractory anti-MDA5 antibody-positive clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonitis who were unable to achieve disease control on intensive combination immunosuppressive therapy with glucocorticoids and immunosuppressive agents. They were treated with tacrolimus trough concentration-escalating bimodal therapy. Patients receiving tacrolimus trough concentration-escalating dual therapy were selected based on poor prognostic factors and refractoriness to the initial immunosuppressive therapy.
resultsThe 19 patients included in the study were treated with tacrolimus trough concentration-escalating bipartite therapy (glucocorticoids combined with tacrolimus) immediately after diagnosis of refractory anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonia. Following 17 months of treatment and subsequent follow-up, 16 patients displayed decreased ferritin and lactate dehydrogenase levels and improved oxygenation index and high-resolution lung computed tomography findings. Two patients died, and one patient (case 9) developed renal impairment on Day 14 of treatment. Renal damage occurred when the tacrolimus trough concentration was 15.68 ng/mL. After lowering the tacrolimus trough concentration, the patient's renal function gradually normalized. However, because of the addition of cyclophosphamide due to disease activity, the patient did not experience the full efficacy of the two-combination therapy. Tacrolimus-associated renal impairment and viral and fungal infections occurred in some patients treated with bimodal therapy, but it did not have serious consequences.
conclusionFor patients with refractory anti-MDA5 antibody-positive clinically amyopathic dermatomyositis associated with rapidly progressive interstitial pneumonia, the combination of glucocorticoids and tacrolimus is a potentially effective treatment regimen. However, there is considerable individual variation in the optimal trough concentration of tacrolimus.
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