Inflammatory myopathies: management of steroid resistance

Dalakas, MC

dc.contributor.author	Dalakas, MC	en
dc.date.accessioned	2014-03-01T02:04:30Z
dc.date.available	2014-03-01T02:04:30Z
dc.date.issued	2011	en
dc.identifier.issn	1350-7540	en
dc.identifier.uri	https://dspace.lib.ntua.gr/xmlui/handle/123456789/29448
dc.subject	immunotherapies	en
dc.subject	inflammatory myopathies	en
dc.subject	monoclonal antibodies	en
dc.subject.classification	Clinical Neurology	en
dc.subject.classification	Neurosciences	en
dc.subject.other	INCLUSION-BODY MYOSITIS	en
dc.subject.other	REFRACTORY POLYMYOSITIS	en
dc.subject.other	INTRAVENOUS IMMUNOGLOBULIN	en
dc.subject.other	THERAPEUTIC TARGETS	en
dc.subject.other	DERMATOMYOSITIS	en
dc.subject.other	MUSCLE	en
dc.subject.other	DISEASE	en
dc.subject.other	FUTURE	en
dc.subject.other	IMMUNOBIOLOGY	en
dc.subject.other	PATHOGENESIS	en
dc.title	Inflammatory myopathies: management of steroid resistance	en
heal.type	journalArticle	en
heal.language	English	en
heal.publicationDate	2011	en
heal.abstract	Purpose of review The inflammatory myopathies include polymyositis, dermatomyositis, necrotizing autoimmune myopathy (NAM), and inclusion body myositis (IBM). On the basis of clinical experience, most patients respond to corticosterioids to some degree or for a time period. For patients insufficiently responding or for steroid-sparing, the treatment options vary among practitioners, generating a genuine uncertainty. This timely review highlights emerging new therapies and provides practical therapeutic algorithms. Recent findings For patients insufficiently responding to corticosteroids, the commonly used immunosuppressants, such as azathioprine, mycophenolate, methotrexate, or cyclosporine, may exert a nonevidence-based 'steroid-sparing' effect but provide minimal benefit on their own. The second line therapy is intravenous immunoglobulin (IVIg) based on a controlled study conducted in dermatomyositis; the drug is also effective in many patients with polymyositis and NAM. Rituximab and tacrolimus may offer additional benefit. Anti-TNF agents are disappointing. IBM remains difficult to treat; although early on some patients may partially respond to steroids or IVIg, they soon become unresponsive and the disease progresses. Emerging agents against T cells, B cells, and transmigration molecules are discussed as promising therapeutic options. Summary New biological agents are in the offing for control trials. Appropriate outcome measures are however needed to assess and monitor responses.	en
heal.publisher	LIPPINCOTT WILLIAMS & WILKINS	en
heal.journalName	CURRENT OPINION IN NEUROLOGY	en
dc.identifier.isi	ISI:000294679400007	en
dc.identifier.volume	24	en
dc.identifier.issue	5	en
dc.identifier.spage	457	en
dc.identifier.epage	462	en