論文

2020年11月1日

Efficacy of plasma exchange in anti-MDA5-positive dermatomyositis with interstitial lung disease under combined immunosuppressive treatment

Rheumatology (Oxford)
  • Mirei Shirakashi
  • ,
  • Ran Nakashima
  • ,
  • Hideaki Tsuji
  • ,
  • Kiminobu Tanizawa
  • ,
  • Tomohiro Handa
  • ,
  • Yuji Hosono
  • ,
  • Shuji Akizuki
  • ,
  • Kosaku Murakami
  • ,
  • Motomu Hashimoto
  • ,
  • Hajime Yoshifuji
  • ,
  • Koichiro Ohmura
  • ,
  • Tsuneyo Mimori

59
11
開始ページ
3284
終了ページ
3292
記述言語
掲載種別
研究論文(学術雑誌)
DOI
10.1093/rheumatology/keaa123

© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com Objectives. Rapidly progressive interstitial lung disease (RP-ILD) with poor prognosis often accompanies anti-melanoma differentiation-associated gene 5 (MDA5)-positive DM. Combined immunosuppressive therapy, including glucocorticoids, calcineurin inhibitors and intravenous cyclophosphamide (IVCY) is reportedly effective in DM with RP-ILD, but some patients remain resistant to therapy. We examined the utility of plasma exchange (PE) in such intractable cases and investigated the prognostic factors of the disease. Methods. Thirty-eight anti-MDA5-positive DM-ILD patients who received the combined immunosuppressive therapy were retrospectively reviewed. Their serum cytokines were evaluated by multiplex assay before treatment. The patients were divided into two groups: those who achieved remission without exacerbation of respiratory dysfunction (n ¼ 25, group A) and those who progressed to hypoxemia during the treatment (n ¼ 13, group B). Results. PE was carried out in eight group B patients, but none of group A. Five of the eight treated with PE survived, while the five untreated patients died (P ¼0.04). Higher neutrophil lymphocyte ratio, higher serum ferritin, hypoxemia, high-resolution computed tomography (HRCT) score before treatment and increase of Krebs von Lungen-6 (KL-6) in the first 4 weeks of the treatment were the prognostic factors for disease progression. Serum cytokines such as IL-1, IL-6, IL-8, IL-10, IL-12p70, IL-18 and sCD163 levels were higher in group B than group A. Conclusion. PE should be an effective adjuvant treatment in anti-MDA5-positive DM with RP-ILD. Assessment of basal laboratory tests or monocyte/macrophage-derived cytokines and the increase of KL-6, HRCT score and hypoxemia may help us to predict intractable cases and to make early treatment decisions regarding PE in antiMDA5-positive DM.

リンク情報
DOI
https://doi.org/10.1093/rheumatology/keaa123
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/32276271
Scopus
https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85091523341&origin=inward
Scopus Citedby
https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=85091523341&origin=inward
ID情報
  • DOI : 10.1093/rheumatology/keaa123
  • ISSN : 1310-0505
  • ORCIDのPut Code : 86759501
  • PubMed ID : 32276271
  • SCOPUS ID : 85091523341

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