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Slater N, Sooda A, McLeish E, Beer K, Brusch A, Shakya R, Bundell C, James I, Chopra A, Mastaglia FL, Needham M, Coudert JD. High-resolution HLA genotyping in inclusion body myositis refines 8.1 ancestral haplotype association to DRB1*03:01:01 and highlights pathogenic role of arginine-74 of DRβ1 chain. J Autoimmun 2024; 142:103150. [PMID: 38043487 DOI: 10.1016/j.jaut.2023.103150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Inclusion body myositis (IBM) is a progressive inflammatory-degenerative muscle disease of older individuals, with some patients producing anti-cytosolic 5'-nucleotidase 1A (NT5C1A, aka cN1A) antibodies. Human Leukocyte Antigens (HLA) is the highest genetic risk factor for developing IBM. In this study, we aimed to further define the contribution of HLA alleles to IBM and the production of anti-cN1A antibodies. METHODS We HLA haplotyped a Western Australian cohort of 113 Caucasian IBM patients and 112 ethnically matched controls using Illumina next-generation sequencing. Allele frequency analysis and amino acid alignments were performed using the Genentech/MiDAS bioinformatics package. Allele frequencies were compared using Fisher's exact test. Age at onset analysis was performed using the ggstatsplot package. All analysis was carried out in RStudio version 1.4.1717. RESULTS Our findings validated the independent association of HLA-DRB1*03:01:01 with IBM and attributed the risk to an arginine residue in position 74 within the DRβ1 protein. Conversely, DRB4*01:01:01 and DQA1*01:02:01 were found to have protective effects; the carriers of DRB1*03:01:01 that did not possess these alleles had a fourteenfold increased risk of developing IBM over the general Caucasian population. Furthermore, patients with the abovementioned genotype developed symptoms on average five years earlier than patients without. We did not find any HLA associations with anti-cN1A antibody production. CONCLUSIONS High-resolution HLA sequencing more precisely characterised the alleles associated with IBM and defined a haplotype linked to earlier disease onset. Identification of the critical amino acid residue by advanced biostatistical analysis of immunogenetics data offers mechanistic insights and future directions into uncovering IBM aetiopathogenesis.
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Affiliation(s)
- Nataliya Slater
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia
| | - Anuradha Sooda
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia
| | - Emily McLeish
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia
| | - Kelly Beer
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Anna Brusch
- PathWest Laboratory Medicine, Dept of Clinical Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - Rakesh Shakya
- PathWest Laboratory Medicine, Dept of Clinical Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - Christine Bundell
- PathWest Laboratory Medicine, Dept of Clinical Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - Ian James
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; Murdoch University, Institute for Immunology and Infection Diseases, Murdoch, WA, Australia
| | - Abha Chopra
- Murdoch University, Institute for Immunology and Infection Diseases, Murdoch, WA, Australia
| | - Frank L Mastaglia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; University of Western Australia, Centre for Neuromuscular & Neurological Disorders, Crawley, WA, Australia
| | - Merrilee Needham
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; University of Notre Dame Australia, School of Medicine, Fremantle, WA, Australia; Fiona Stanley Hospital, Department of Neurology, Murdoch, WA, Australia
| | - Jerome D Coudert
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; University of Notre Dame Australia, School of Medicine, Fremantle, WA, Australia.
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2
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Bellofatto IA, Sessarego M, Tirandi A, Olivero C, Sgura C, Maioli E, Gavoci A, Schiavetta E, Frè F, Saccomanno B, Zaottini F, Picasso R, Fiorillo C, Liberale L, Ottonello LC, Bardi N, Montecucco F. Statin-Induced Necrotizing Autoimmune Myopathy: Case Report of a Patient under Chronic Treatment. Case Rep Med 2023; 2023:6550473. [PMID: 38145276 PMCID: PMC10748725 DOI: 10.1155/2023/6550473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/05/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction 3-Hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) inhibitors are widely used worldwide to treat dyslipidaemia and prevent cardiovascular events. Statins can cause a wide variety of muscle injuries ranging from myalgia to severe rhabdomyolysis. In most cases, these symptoms are mild and self-limiting and do not require specific treatment besides drug withdrawal. Statin-induced autoimmune necrotizing myopathy (SINAM) is a rare but potentially fatal complication, characterized by the subacute onset of progressive proximal muscle weakness and considerably high creatine phosphokinase (CK) levels in patients exposed to statins. The diagnosis is supported by the presence of antibodies HMGCR, which allows the differentiation from other forms of necrotizing autoimmune myopathies. Symptoms usually progress even after statin discontinuation and can determine severe muscle damage. Summary. We describe the case of a 77-year-old man who developed SINAM after 5 years of statin use. He suffered from muscle functional impairment mainly involving proximal lower limb muscles which progressed to the point that he almost became bedridden. Initial treatment with prednisone alone was not effective, and he required a combination therapy with steroids, methotrexate, and intravenous immunoglobulins. After 5 months of therapy and rehabilitation, he showed complete laboratory response and muscle strength recovery. Conclusion Recognizing SINAM is paramount in order to promptly start treatment and avoid permanent muscle damage. Using a combination therapy from the beginning could contribute to a better outcome. Prompt statin cessation, categorization of the muscle disease by autoantibody testing, imaging, and histology, exclusion of malignancy, and anti-inflammatory therapy with corticosteroids, antimetabolites, immunoglobulins, and in some cases rituximab are currently accepted approaches to this entity.
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Affiliation(s)
- Ilaria Anna Bellofatto
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Marta Sessarego
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Amedeo Tirandi
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Chiara Olivero
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Cosimo Sgura
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Elia Maioli
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Aurora Gavoci
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Elisa Schiavetta
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Federica Frè
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Benedetta Saccomanno
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Federico Zaottini
- Radiology Unit, Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, Genoa 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Benzi 10, Genoa 16132, Italy
| | - Riccardo Picasso
- Radiology Unit, Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, Genoa 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Benzi 10, Genoa 16132, Italy
| | - Chiara Fiorillo
- Pediatric Neurology and Muscular Diseases Unit, University of Genoa and G. Gaslini Institute, Via Gaslini 5, Genoa 16132, Italy
| | - Luca Liberale
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, No.6, Genoa 16132, Italy
| | - Luciano Carlo Ottonello
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Nicholas Bardi
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Larogo Benzi 10, Genoa 16132, Italy
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, No.6, Genoa 16132, Italy
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Paul M, Paul P, Dey D, Moazzem SW, Shamrin F. A Case of Statin-Associated Immune-Mediated Necrotizing Myopathy, Successfully Treated With Intravenous Immunoglobulin. Cureus 2021; 13:e16001. [PMID: 34336492 PMCID: PMC8318619 DOI: 10.7759/cureus.16001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/05/2022] Open
Abstract
Statins have become the commonest lipid-lowering agent worldwide and have significantly reduced morbidity and mortality associated with cardiovascular diseases. Overall, statins are very well tolerated. However, in clinical practice, a wide variety of skeletal myopathic effects have been observed, ranging from asymptomatic patients with high creatine phosphokinase (CPK) to fatal cases of acute rhabdomyolysis. Recent reports suggest that statins are associated with immune-mediated necrotizing myopathy (IMNM), a unique autoimmune myopathy. Unlike other drug reactions, this can occur months to years after initiation of statin. It is a distinctive autoimmune myopathy where symptoms persist or even progress after statin discontinuation and requires immunosuppressive therapy. The presence of anti-hydroxy-methyl-glutaryl coenzyme-A reductase (HMGCR) antibody in serum strengthens the diagnosis of statin-associated necrotizing myopathy. Here we present a case of statin-associated IMNM in a 43-year-old Caucasian female who had statin-induced progressive deterioration of proximal muscle weakness with poor response to high-dose steroids and required further immunosuppressive therapy.
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Affiliation(s)
- Mishouri Paul
- Medicine, Interfaith Medical Center, New York City, USA
| | - Prodip Paul
- Internal Medicine, Geisinger Community Medical Center, Scranton, USA
| | - Dipon Dey
- Epidemiology and Public Health, ZWH Medical Care PC, Queens, USA
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van Landingham SW, Puccetti D, Potter H, Gamm D, Diamond EL, Lucarelli MJ. Necrotizing myositis in a rectus muscle arising in the setting of long-standing Langerhans cell histiocystosis and recent dabrafenib treatment. Am J Ophthalmol Case Rep 2020; 20:100868. [PMID: 32875153 PMCID: PMC7452147 DOI: 10.1016/j.ajoc.2020.100868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/07/2020] [Accepted: 08/09/2020] [Indexed: 10/24/2022] Open
Abstract
Purpose to describe an unusual case of necrotizing myositis in a rectus muscle, possibly related to BRAF inhibitor therapy. Observations An 18-year old man with neurodegenerative Langerhans cell histiocytosis (LCH), recently started on the BRAF inhibitor dabrafenib, presented with right eye pain. Magnetic resonance imaging (MRI) orbits revealed a rectus muscle mass concerning for LCH recurrence or malignancy. Dabrafenib was stopped, and incisional biopsy of the mass was performed. The mass was absent on post-operative MRI, so no further treatment was pursued. Histopathologic evaluation was initially concerning for sarcoma, but on further analysis, appeared more consistent with necrotizing myositis. The mass did not recur, nor did the patient develop other signs or symptoms concerning for myositis or malignancy over a 24-month follow-up period. Conclusions Necrotizing myositis has not been previously described in a rectus muscle or with BRAF inhibitor use, though myalgias and malignancies are established side effects. Necrotizing myositis may masquerade as sarcoma and should be on the differential diagnosis for a new mass in the setting of dabrafenib therapy.
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Affiliation(s)
- Suzanne W van Landingham
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 2828 University Avenue, Madison, WI, 53705, USA
| | - Diane Puccetti
- Department of Pediatrics, American Family Children's Hospital University of Wisconsin-Madison, 1675 Highland Avenue, Madison, WI, 53792, USA
| | - Heather Potter
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 2828 University Avenue, Madison, WI, 53705, USA
| | - David Gamm
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 2828 University Avenue, Madison, WI, 53705, USA.,McPherson Eye Research Institute and Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mark J Lucarelli
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 2828 University Avenue, Madison, WI, 53705, USA
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Wu S, Peng W, Zhang Y, Guo J, Fu J, Wang W. Correlation of PMN elastase and PMN elastase-to-neutrophil ratio with disease activity in patients with myositis. J Transl Med 2019; 17:420. [PMID: 31842908 PMCID: PMC6912949 DOI: 10.1186/s12967-019-02176-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022] Open
Abstract
Background Polymorphonuclear (PMN) elastase plays an important role in a variety of inflammatory disorders. Our aim was to analyse PMN elastase in idiopathic inflammatory myopathies (IIMs) and its association with disease activity. Methods PMN elastase levels were measured using enzyme-linked immunosorbent assay in serum samples obtained from 74 patients with myositis (58 with dermatomyositis [DM] and 16 with polymyositis [PM]) and 22 healthy controls. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminant capacity of PMN elastase level and PMN elastase-to-neutrophil ratio (ENR) in patients with active and remission myositis. The association of serum PMN elastase level and ENR with disease variables was evaluated in patients with IIMs. The disease specificity of PMN elastase level and ENR was further examined in 60 patients with other systemic autoimmune diseases. Results PMN elastase level and ENR were significantly higher in patients with active IIMs, DM, and PM than in patients with remission. ROC curve analysis revealed that PMN elastase level and ENR both outperformed creatine kinase (CK), the currently used laboratory marker, and strongly discriminated patients with active disease and those with remission of IIMs, DM, and PM (area under the ROC curve [AUC] 0.9, 0.9, and 0.88 for PMN elastase; AUC 0.96, 0.96, and 1.0 for ENR; AUC 0.72, 0.70, and 0.80 for CK, respectively). PMN elastase level and ENR were positively correlated with myositis disease activity assessment, CK, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, and erythrocyte sedimentation rate. PMN elastase level and ENR were higher in the anti-PM-Scl positive myositis group than those in the anti-PM-Scl negative myositis group. Nevertheless, PMN elastase was not a specific disease marker for IIMs when compared with other autoimmune diseases. Conclusions PMN elastase, particularly ENR, were significantly correlated with disease activity and could serve as useful biochemical markers for evaluating the disease activity of patients with IIMs. Thus, they are potentially helpful in monitoring disease progression and guiding treatment.
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Affiliation(s)
- Siyu Wu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Wanchan Peng
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Yunli Zhang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Jingjing Guo
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Jinfang Fu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Wei Wang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China.
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Prior DE, Nurre E, Roller SL, Kline D, Panara R, Stino AM, Davis JA, Freimer ML, Arnold WD. Infections and the relationship to treatment in neuromuscular autoimmunity. Muscle Nerve 2017; 57:927-931. [PMID: 29211921 DOI: 10.1002/mus.26032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION This study aimed to identify infections in patients with myasthenia gravis, dermatomyositis, and chronic inflammatory demyelinating polyradiculoneuropathy, and to investigate the relationship between infection and immunomodulation. METHODS A retrospective chart review examined 631 patients with myasthenia gravis (n = 358), chronic inflammatory demyelinating polyradiculoneuropathy (n = 124), and dermatomyositis (n = 149) patients over a 10-year time period. RESULTS Infection rates were similar at approximately 19% in all 3 diseases. Of the infections in which a causative organism was identified, pneumonia, sepsis, and opportunistic infections were the leading diagnoses. A multivariate model demonstrated a significant association between infection and an increased dose of plasma exchange, mycophenolate mofetil, and corticosteroid therapy. DISCUSSION There are few large studies investigating rates of infections in patients with autoimmune neuromuscular disorders and the relationship to immunomodulation. This study not only demonstrates the remarkably similar infection rates across the 3 diseases studied, but also shows their relationship to commonly used immunotherapies. Muscle Nerve 57: 927-931, 2018.
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Affiliation(s)
- Devin E Prior
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emily Nurre
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephanie L Roller
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David Kline
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Ramit Panara
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amro M Stino
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John A Davis
- Department of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Miriam L Freimer
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Neurology, Division of Neuromuscular Medicine, The Ohio State University Wexner Medical Center, 395 West 12th Avenue Columbus, Ohio, 43210, USA
| | - W David Arnold
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Neurology, Division of Neuromuscular Medicine, The Ohio State University Wexner Medical Center, 395 West 12th Avenue Columbus, Ohio, 43210, USA.,Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Knight T, Bond TC, Popelar B, Wang L, Niewoehner JW, Anastassopoulos K, Philbin M. Medical resource utilization in dermatomyositis/polymyositis patients treated with repository corticotropin injection, intravenous immunoglobulin, and/or rituximab. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:271-279. [PMID: 28553129 PMCID: PMC5440004 DOI: 10.2147/ceor.s130992] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Dermatomyositis and polymyositis (DM/PM) are rare, incurable inflammatory diseases that cause progressive muscle weakness and can be associated with increased medical resource use (MRU). When corticosteroid treatment is unsuccessful, patients may receive intravenous immunoglobulin (IVIg), rituximab, or repository corticotropin injection (RCI). This study compared real-world, non-medication MRU between patients treated with RCI and those treated with IVIg and/or rituximab for DM/PM. Methods Claims of DM/PM patients were analyzed from the combination of three commercial health insurance databases in the United States from July 2009 to June 2014. Patients treated with RCI were propensity score matched to those treated with IVIg, rituximab, and both (IVIg+rituximab) based on demographics, prior clinical characteristics, and prior MRU. Per-patient per-month (PPPM) MRU and costs were compared using Poisson regression and generalized linear modeling, respectively. Results One-hundred thirty-two RCI, 1,150 IVIg, and 562 rituximab patients had an average age of 52.6, 46.6, and 51.7 years, respectively, and roughly two-thirds were female. After matching, there were no significant differences in demographics or prior clinical characteristics. RCI patients had fewer PPPM hospitalizations (0.09 vs 0.17; P=0.049), shorter length of stay (LOS; 3.24 days vs 4.55 days; P=0.004), PPPM hospital outpatient department (HOPD) visits (0.60 vs 1.39; P<0.001), and PPPM physician office visits (2.01 vs 2.33; P=0.035) than IVIg. RCI had fewer PPPM HOPD visits (0.56 vs 0.92; P<0.001) than rituximab. Patients treated with RCI had shorter LOS (2.18 days vs 5.15; P<0.001) and less PPPM HOPD visits (0.53 vs 1.26; P<0.001) than IVIg+rituximab. Total non-medication PPPM costs were 23%–75% lower for RCI compared to IVIg ($2,126 vs $3,964; P<0.001), rituximab ($2,008 vs $2,607; P=0.018), and IVIg+rituximab ($1,234 vs $4,858; P<0.001). Conclusion Patients treated with RCI had less PPPM non-medication MRU and costs than those treated with IVIg and/or rituximab, particularly in the hospital setting where significant costs are incurred.
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Affiliation(s)
- Tyler Knight
- Covance Market Access Services Inc., Gaithersburg, MD
| | | | | | - Li Wang
- STATinMED Research, Ann Arbor, MI
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Dalakas MC. Neuro-Immunotherapies: A 30-year Retrospective of an Overwhelming Success and a Brighter Future. Neurotherapeutics 2016; 13:1-3. [PMID: 26684870 PMCID: PMC4720665 DOI: 10.1007/s13311-015-0414-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marinos C Dalakas
- Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, USA.
- Neuroimmunology, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
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