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Intravenous immunoglobulin helped to maintain dermatomyositis remission

The short- and long-term prognoses for patients with dermatomyositis may be improved by the addition of intravenous immunoglobulin to their treatments, according to recent results.

In a cohort of 42 patients with dermatomyositis, 24 received intravenous immunoglobulin (IVIG) as an additional treatment and 18 received conventional immunosuppression. Researchers conducted follow-up after 6 months, and continued to evaluate muscular and cutaneous involvement for a median of 76 months.

Patients undergoing IVIG received a median of six monthly doses (range 4-18). At 6 months, patients treated with IVIG experienced a significantly higher muscular remission rate compared with untreated patients (91.7% vs. 55.6%, P=.007). Complete remission occurred in 50% of IVIG patients and 44.4% of untreated patients, and the difference was statistically insignificant (P=.28). Relapse occurred in 54.2% of IVIG patients during the 48-month follow-up period, with a mean relapse-free period of 38.5±34.3 months. Muscle relapses occurred in 16.7% of these patients, with the remainder of the relapses related to cutaneous involvement. Patients who received a larger number of IVIG pulses experienced fewer relapses during a 35-month period (P=.03).

Both Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and Medical Research Council (MRC) scores improved among IVIG patients after treatment, with CDASI scores decreasing from 7.46±6.26 to 2.96±3.64 and MRC scores increasing from 6.71±1.6 to 9.54±1.02 after six months (P<.001). By the end of the follow-up period, the overall CDASI and MRC scores were 1.95±1.72 and 9.56±0.66, respectively, and the difference from pre-treatment scores was statistically significant (P<.001).

Adverse events occurred in 16.7% of IVIG patients. The majority of events were mild and included headaches and migraines.

“The immediate outcome of IVIG is significantly better than that of conventional medications,” the researchers wrote. “During long-term follow-up, IVIG treated patients experienced relatively few muscular relapses, and had a less severe course of the disease. … Further prospective studies, including larger patient populations, are needed to confirm these findings and to compare long-term results between groups of patients that maintain on [the] same types and doses of drugs.”