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14 September 2024 : Review article  

Pharmacological Strategies in Dermatomyositis: Current Treatments and Future Directions

Jinqiang Guo ORCID logo1EF, Weiwei Wang1EF, Anbin Huang1E, Chunli Mei1AE*

DOI: 10.12659/MSM.944564

Med Sci Monit 2024; 30:e944564

Table 1 Drug treatments for dermatomyositis.

DrugMechanism of actionIndicationsDosage and administrationAdverse effects
PrednisoneSuppresses the inflammatory and immune responsesInitial treatment1–2 mg/kg/dayGastrointestinal discomfort, increased risk of infection, osteoporosis, diabetes
AzathioprineInhibits DNA and RNA synthesis, reducing T-cell activityCombination therapy1–3 mg/kg/dayBone marrow suppression, hepatotoxicity, nausea, vomiting, increased risk of infection
MethotrexateInhibits inflammatory responseCombination therapy7.5–25 mg/weekGastrointestinal discomfort, hepatotoxicity, oral ulcers, pulmonary fibrosis
Mycophenolate mofetilInhibits T- and B-lymphocyte proliferationCombination therapy, especially with ILD2–3 g/dayGastrointestinal discomfort, increased risk of infection, leukopenia
Cyclosporin AInhibits T-cell activationRefractory patients2.5–5 mg/kg/dayNephrotoxicity, hypertension, gingival hyperplasia, hirsutism
TacrolimusInhibits T-cell activationRefractory patients0.1–0.2 mg/kg/dayNephrotoxicity, hypertension, diabetes, neurotoxicity
CyclophosphamideInhibits immune cell proliferationSevere patients, especially with ILD0.5–2 g/m/monthBone marrow suppression, increased risk of infection, cystitis, alopecia
Intravenous immunoglobulinNeutralizes autoantibodies and modulates the immune systemSevere patients2 g/kg/4 weeksAllergic reactions, increased risk of infection, thrombosis
RituximabDepletes B cells by targeting CD20Refractory patients375 mg/m/weekInfusion reactions, increased risk of infection, hypotension, respiratory difficulties
TofacitinibBlocks JAK pathwaysRefractory patients5–10 mg/dayIncreased risk of infection, hepatotoxicity, dyslipidemia
UpadacitinibBlocks JAK pathwaysRefractory patients15 mg/dayIncreased risk of infection, hepatotoxicity, dyslipidemia
ILD – interstitial lung disease; JAK – Janus kinase.

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750