14 September 2024 : Review article
Pharmacological Strategies in Dermatomyositis: Current Treatments and Future Directions
Jinqiang Guo 1EF, Weiwei Wang1EF, Anbin Huang1E, Chunli Mei1AE*DOI: 10.12659/MSM.944564
Med Sci Monit 2024; 30:e944564
Table 1 Drug treatments for dermatomyositis.
Drug | Mechanism of action | Indications | Dosage and administration | Adverse effects |
---|---|---|---|---|
Prednisone | Suppresses the inflammatory and immune responses | Initial treatment | 1–2 mg/kg/day | Gastrointestinal discomfort, increased risk of infection, osteoporosis, diabetes |
Azathioprine | Inhibits DNA and RNA synthesis, reducing T-cell activity | Combination therapy | 1–3 mg/kg/day | Bone marrow suppression, hepatotoxicity, nausea, vomiting, increased risk of infection |
Methotrexate | Inhibits inflammatory response | Combination therapy | 7.5–25 mg/week | Gastrointestinal discomfort, hepatotoxicity, oral ulcers, pulmonary fibrosis |
Mycophenolate mofetil | Inhibits T- and B-lymphocyte proliferation | Combination therapy, especially with ILD | 2–3 g/day | Gastrointestinal discomfort, increased risk of infection, leukopenia |
Cyclosporin A | Inhibits T-cell activation | Refractory patients | 2.5–5 mg/kg/day | Nephrotoxicity, hypertension, gingival hyperplasia, hirsutism |
Tacrolimus | Inhibits T-cell activation | Refractory patients | 0.1–0.2 mg/kg/day | Nephrotoxicity, hypertension, diabetes, neurotoxicity |
Cyclophosphamide | Inhibits immune cell proliferation | Severe patients, especially with ILD | 0.5–2 g/m/month | Bone marrow suppression, increased risk of infection, cystitis, alopecia |
Intravenous immunoglobulin | Neutralizes autoantibodies and modulates the immune system | Severe patients | 2 g/kg/4 weeks | Allergic reactions, increased risk of infection, thrombosis |
Rituximab | Depletes B cells by targeting CD20 | Refractory patients | 375 mg/m/week | Infusion reactions, increased risk of infection, hypotension, respiratory difficulties |
Tofacitinib | Blocks JAK pathways | Refractory patients | 5–10 mg/day | Increased risk of infection, hepatotoxicity, dyslipidemia |
Upadacitinib | Blocks JAK pathways | Refractory patients | 15 mg/day | Increased risk of infection, hepatotoxicity, dyslipidemia |
ILD – interstitial lung disease; JAK – Janus kinase. |