Predictors of Clinical Improvement in Rituximab-Treated Refractory Adult and Juvenile Dermatomyositis and Adult Polymyositis

被引:204
作者
Aggarwal, Rohit [1 ]
Bandos, Andriy [1 ]
Reed, Ann M. [2 ]
Ascherman, Dana P. [3 ]
Barohn, Richard J. [4 ]
Feldman, Brian M. [5 ,6 ]
Miller, Frederick W. [7 ]
Rider, Lisa G. [7 ]
Harris-Love, Michael O. [8 ]
Levesque, Marc C. [1 ]
Oddis, Chester V. [1 ]
机构
[1] Univ Pittsburgh, Pittsburgh, PA 15261 USA
[2] Mayo Clin, Rochester, MN USA
[3] Univ Miami, Miami, FL USA
[4] Univ Kansas, Med Ctr, Kansas City, KS 66103 USA
[5] Hosp Sick Children, Toronto, ON, Canada
[6] Univ Toronto, Toronto, ON, Canada
[7] Natl Inst Environm Hlth Sci, NIH, Bethesda, MD USA
[8] Washington DC VA Med Ctr, Washington, DC USA
关键词
IDIOPATHIC INFLAMMATORY MYOPATHIES; TRANSFER-RNA-SYNTHETASE; MYOSITIS-SPECIFIC AUTOANTIBODIES; PROGNOSTIC-FACTORS; JAPANESE PATIENTS; DISEASE-ACTIVITY; TERM; SURVIVAL; ANTIBODY; TRIAL;
D O I
10.1002/art.38270
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. To identify the clinical and laboratory predictors of clinical improvement in a cohort of myositis patients treated with rituximab. Methods. We analyzed data for 195 patients with myositis (75 with adult polymyositis [PM], 72 with adult dermatomyositis [DM], and 48 with juvenile DM) in the Rituximab in Myositis trial. Clinical improvement was defined as 20% improvement in at least 3 of the following 6 core set measures of disease activity: physician's and patient's/parent's global assessment of disease activity, manual muscle testing, physical function, muscle enzymes, and extramuscular disease activity. We analyzed the association of the following baseline variables with improvement: myositis clinical subgroup, demographics, myositis damage, clinical and laboratory parameters, core set measures, rituximab treatment, and myositis autoantibodies (antisynthetase, anti-Mi-2, anti-signal recognition particle, anti-transcription intermediary factor 1 gamma [TIF-1 gamma], anti-MJ, other autoantibodies, and no autoantibodies). All measures were univariately assessed for association with improvement using time-to-event analyses. A multivariable time-dependent proportional hazards model was used to evaluate the association of individual predictive factors with improvement. Results. In the final multivariable model, the presence of an antisynthetase, primarily anti-Jo-1 (hazard ratio [HR] 3.08, P < 0.01), anti-Mi-2 (HR 2.5, P < 0.01), or other autoantibody (HR 1.4, P = 0.14) predicted a shorter time to improvement compared to the absence of autoantibodies. A lower physician's global assessment of damage (HR 2.32, P = 0.02) and juvenile DM (versus adult myositis) (HR 2.45, P = 0.01) also predicted improvement. Unlike autoantibody status, the predictive effect of physician's global assessment of damage and juvenile DM diminished by week 20. Rituximab treatment did not affect these associations. Conclusion. Our findings indicate that the presence of antisynthetase and anti-Mi-2 autoantibodies, juvenile DM subset, and lower disease damage strongly predict clinical improvement in patients with refractory myositis.
引用
收藏
页码:740 / 749
页数:10
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