A therapeutic perspective for refractory polymyositis to corticosteroids and immunosuppressant drugs: A case report
DOI:
https://doi.org/10.22122/cdj.v9i1.589Keywords:
Polymyositis, Resistance, Corticosteroid, Immunosuppressant, Drugs, RituximabAbstract
BACKGROUND: Polymyositis (PM) is a chronic, disabling, and progressive inflammatory disease with muscle and systemic involvement. Although it is uncommon, some patients may present drug resistance to initial treatment with corticosteroid and immunosuppressant drugs.
CASE REPORT: In this study, a typical case of poor prognosis of a 40-year-old female with PM who presented resistance to the initial treatment with corticosteroids and immunosuppressants was presented. The first medication tested was prednisone for 30 days and then 5 pulses of methylprednisolone were performed for
5 months, and since there was no effect, a combination of azathioprine and methotrexate was performed for
8 months, which was also unsatisfactory. Then, the scheme was changed to cyclophosphamide, human immunoglobulin (HIG), and cyclosporine, which were also unable to change the clinical course of the disease, which led the prescriber to radically change the drug therapy to the immunobiological rituximab (RTX), the only medication capable of ensuring an excellent therapy response and recovery of muscle strength.
CONCLUSION: This report demonstrates the importance of the necessary persistence for the prescriber to test certain classes and drug combinations in search of the best possible therapeutic response for the specific case, which only occurred after the prescription and proscription of the drugs of first choice and the change to the immunobiological drug, RTX.
References
Dalakas MC. Inflammatory muscle diseases. N Engl J Med 2015; 372(18): 1734-47.
Jakubaszek M, Kwiatkowska B, Maslinska M. Polymyositis and dermatomyositis as a risk of developing cancer. Reumatologia 2015; 53(2): 101-5.
Oddis CV. Update on the pharmacological treatment of adult myositis. J Intern Med 2016; 280(1): 63-74.
Milisenda JC, Selva-O'Callaghan A, Grau JM. The diagnosis and classification of polymyositis. J Autoimmun 2014; 48-49: 118-21.
Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol 2011; 335(1): 2-13.
de Souza FHC, de Araujo DB, Vilela VS, Bezerra MC, Simoes RS, Bernardo WM, et al. Guidelines of the Brazilian Society of Rheumatology for the treatment of systemic autoimmune myopathies. Adv Rheumatol 2019; 59(1): 6.
Mathur T, Manadan AM, Thiagarajan S, Hota B, Block JA. Corticosteroid monotherapy is usually insufficient treatment for idiopathic inflammatory myopathy. Am J Ther 2015; 22(5): 350-4.
Valiyil R, Casciola-Rosen L, Hong G, Mammen A, Christopher-Stine L. Rituximab therapy for myopathy associated with anti-signal recognition particle antibodies: A case series. Arthritis Care Res (Hoboken) 2010; 62(9): 1328-34.
Gheita TA, Gheita HA, Kenawy SA. Rituximab restored the muscle power and rescued from a refractory fatal respiratory failure in a patient with elderly-onset polymyositis. Joint Bone Spine 2012; 79(1): 101-2.
Mok CC, Ho LY, To CH. Rituximab for refractory polymyositis: An open-label prospective study. J Rheumatol 2007; 34(9): 1864-8.
Belhassen-Garcia M, Rabano-Gutierrez A, Velasco-Tirado V, Romero-Alegria A, Perez-Garcia ML, Martin-Oterino JA. Atypical progressive multifocal leukoencephalopathy in a patient with antisynthetase syndrome. Intern Med 2015; 54(5): 519-24.
Wilkinson L, Verhoog NJD, Louw A. Disease- and treatment-associated acquired glucocorticoid resistance. Endocr Connect 2018; 7(12): R328-R349.
Desmet SJ, De BK. Glucocorticoid receptors: Finding the middle ground. J Clin Invest 2017; 127(4): 1136-45.
Barsotti S, Lundberg IE. Current treatment for myositis. Curr Treatm Opt Rheumatol 2018; 4(4): 299-315.
Morisset J, Johnson C, Rich E, Collard HR, Lee JS. Management of myositis-related interstitial lung disease. Chest 2016; 150(5): 1118-28.
Patwardhan A. The value of intravenous immunoglobulin therapy in idiopathic inflammatory myositis in the current transformed era of biologics. Cureus 2020; 12(2): e7049.
Fasano S, Gordon P, Hajji R, Loyo E, Isenberg DA. Rituximab in the treatment of inflammatory myopathies: A review. Rheumatology (Oxford) 2017; 56(1): 26-36.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Chronic Diseases Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
