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Thong L, Chawke LJ, Murphy G, Henry MT. "Management of myositis associated interstitial lung disease". Rheumatol Int 2023; 43:1209-1220. [PMID: 37126103 DOI: 10.1007/s00296-023-05336-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
Idiopathic inflammatory myopathies (IIM) are rare disorders characterised by the presence of skeletal muscle inflammation, with interstitial lung disease (ILD) being the most frequent pulmonary manifestation. The spectrum of clinical presentations of myositis related ILD (M-ILD) encompasses a chronic process to a rapidly progressive ILD (RP-ILD); which is associated with a high mortality rate. The most effective treatments remain controversial and poses a unique challenge to both rheumatologists and respiratory physicians to manage. Given the rare heterogenous nature of M-ILD, there is a paucity of data to guide treatment. The cornerstone of existing treatments encompasses combinations of immunosuppressive therapies, as well as non-pharmacological therapies. In this review, we aim to summarize the current pharmacological therapies (including its dosing regimens and side effects profiles) and non-pharmacological therapies. Based on the existing literature to date, we propose a treatment algorithm for both chronic M-ILD and RP-ILD.
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Affiliation(s)
- Lorraine Thong
- Department of Clinical Medicine, Trinity Translational Medical Institute, Trinity College Dublin, St. James Hospital, Dublin, Ireland.
| | - Liam J Chawke
- Department of Clinical Medicine, University Hospital Kerry, Kerry, Ireland
| | - Grainne Murphy
- Department of Rheumatology, Cork University Hospital, Cork, Ireland
| | - Michael T Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
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Kagitani M, Nomi H, Azuma H. Clinical parameters of therapeutic apheresis induction in clinically amyopathic dermatomyositis patients with rapid progressive interstitial lung disease. Ther Apher Dial 2023; 27:152-158. [PMID: 35704548 DOI: 10.1111/1744-9987.13898] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The purpose of this study is to clarify the clinical parameters of therapeutic apheresis (TA) induction in clinically amyopathic dermatomyositis patients with rapid progressive interstitial lung disease. METHODS Literature publications prior to November 2021 from PubMed and Ichushi-Web were used. We collected details of TA and clinical features. The data were divided into two groups determined by the outcome, survived and deceased. Then, we estimated clinical parameters between them. RESULTS There were 151 cases, 134 of which had reported outcomes and 64 of which were positive for the anti-MDA5 antibody. Eighty patients survived. Forty-eight patients were treated with plasma exchange and 34 with polymyxin-B immobilized fibers direct hemoperfusion. Regarding clinical parameters, only the PaO2 to FiO2 (P/F) ratio was useful. The cut-off point of the P/F ratio was 174 on the ROC curve. CONCLUSION The parameter for induction is considered when the P/F ratio is lower than 200.
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Affiliation(s)
- Maki Kagitani
- Blood Purification Center, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
| | - Hayahito Nomi
- Blood Purification Center, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
| | - Haruhito Azuma
- Blood Purification Center, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
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Selva-O'Callaghan A, Romero-Bueno F, Trallero-Araguás E, Gil-Vila A, Ruiz-Rodríguez JC, Sánchez-Pernaute O, Pinal-Fernández I. Pharmacologic Treatment of Anti-MDA5 Rapidly Progressive Interstitial Lung Disease. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021; 7:319-333. [PMID: 34603940 PMCID: PMC8476986 DOI: 10.1007/s40674-021-00186-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/15/2022]
Abstract
Purpose of the Review Idiopathic inflammatory myopathies are a heterogeneous group of autoimmune disorders. The presence of different autoantibodies allows clinicians to define distinct phenotypes. Antibodies against the melanoma differentiation-associated protein 5 gene, also called anti-MDA5 antibodies, are associated with a characteristic phenotype, the clinically amyopathic dermatomyositis with rapidly progressive interstitial lung disease. This review aims to analyze the different pharmacological options for the treatment of rapidly progressive interstitial lung disease in patients with anti-MDA5 antibodies. Recent Findings Evidence-based therapeutic recommendations suggest that the best initial approach to treat these patients is an early combination of immunosuppressive drugs including either glucocorticoids and calcineurin inhibitors or a triple therapy adding intravenous cyclophosphamide. Tofacitinib, a Janus kinase inhibitor, could be useful according to recent reports. High ferritin plasma levels, generalized worsening of pulmonary infiltrates, and ground-glass opacities should be considered predictive factors of a bad outcome. In this scenario, clinicians should consider rescue therapies such as therapeutic plasma exchange, polymyxin-B hemoperfusion, veno-venous extracorporeal membrane oxygenation, or even lung transplantation. Summary Combined immunosuppressive treatment should be considered the first-line therapy for patients with anti-MDA5 rapidly progressive interstitial lung disease. Aggressive rescue therapies may be useful in refractory patients.
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Affiliation(s)
- A Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Medicine Department, Vall d'Hebron University Hospital, GEAS Group, Universitat Autónoma de Barcelona, 08012 Barcelona, Spain
| | - F Romero-Bueno
- Rheumatology Department, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - E Trallero-Araguás
- Rheumatology Department, Vall d'Hebron University Hospital, GEAS Group, Barcelona, Spain
| | - A Gil-Vila
- Systemic Autoimmune Diseases Unit, Medicine Department, Vall d'Hebron University Hospital, GEAS Group, Universitat Autónoma de Barcelona, 08012 Barcelona, Spain
| | - J C Ruiz-Rodríguez
- Intensive Care Department, Vall d'Hebron University Hospital, Shock, Organ Dysfunction, and Resuscitation Research Group, Vall D'Hebron Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - O Sánchez-Pernaute
- Rheumatology Department, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - I Pinal-Fernández
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA.,Johns Hopkins University School of Medicine, Baltimore, MD USA.,Faculty of Health Sciences and Faculty of Computer Science, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
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Tsuji H, Nakashima R, Hosono Y, Imura Y, Yagita M, Yoshifuji H, Hirata S, Nojima T, Sugiyama E, Hatta K, Taguchi Y, Katayama M, Tanizawa K, Handa T, Uozumi R, Akizuki S, Murakami K, Hashimoto M, Tanaka M, Ohmura K, Mimori T. Multicenter Prospective Study of the Efficacy and Safety of Combined Immunosuppressive Therapy With High-Dose Glucocorticoid, Tacrolimus, and Cyclophosphamide in Interstitial Lung Diseases Accompanied by Anti-Melanoma Differentiation-Associated Gene 5-Positive Dermatomyositis. Arthritis Rheumatol 2020; 72:488-498. [PMID: 31524333 DOI: 10.1002/art.41105] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Interstitial lung disease (ILD) accompanied by anti-melanoma differentiation-associated gene 5 (anti-MDA-5)-positive dermatomyositis (DM) is often rapidly progressive and associated with poor prognosis. Because there is no established treatment, we undertook this study to prospectively evaluate the efficacy and safety of a combined immunosuppressive regimen for anti-MDA-5-positive DM patients with ILD. METHODS Adult Japanese patients with new-onset anti-MDA-5-positive DM with ILD (n = 29) were enrolled at multiple study centers from 2014 to 2017. They were treated with a regimen of high-dose glucocorticoids (GCs), tacrolimus, and intravenous cyclophosphamide (IV CYC). Plasmapheresis was used if a patient's condition worsened after the regimen started. The primary end point was 6-month survival, which was compared between this group of patients and a historical control group (n = 15) consisting of anti-MDA-5-positive DM patients with ILD who received step-up treatment (high-dose GC and stepwise addition of immunosuppressant). Secondary end points were 12-month survival rate, adverse events, and changes in laboratory data. RESULTS The combined immunosuppressive regimen group showed significantly higher 6-month survival rates than the step-up treatment group (89% versus 33%; P < 0.0001). Over a period of 52 weeks, improvements in anti-MDA-5 titers, serum ferritin levels, vital capacity, and chest high-resolution computed tomography scores were observed. The combined immunosuppressive regimen group received IV CYC nearly 20 days earlier with shorter intervals and tended to receive plasmapheresis more often than patients undergoing step-up treatment. Cytomegalovirus reactivation was frequently observed over 52 weeks. CONCLUSION A combined immunosuppressive regimen is effective for anti-MDA-5-positive DM patients with ILD. Plasmapheresis can be used for additional effect in intractable disease. Patients should be carefully monitored for opportunistic infections during treatment.
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Affiliation(s)
- Hideaki Tsuji
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ran Nakashima
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuji Hosono
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | - Tomohiro Handa
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuji Uozumi
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuji Akizuki
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Masao Tanaka
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Tsuneyo Mimori
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Treatment of Interstitial Lung Disease Associated With Myositis and the Anti-Synthetase Syndrome. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0111-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hoa S, Troyanov Y, Fritzler MJ, Targoff IN, Chartrand S, Mansour AM, Rich E, Boudabbouz H, Bourré-Tessier J, Albert M, Goulet JR, Landry M, Senécal JL. Describing and expanding the clinical phenotype of anti-MDA5-associated rapidly progressive interstitial lung disease: case series of nine Canadian patients and literature review. Scand J Rheumatol 2017; 47:210-224. [DOI: 10.1080/03009742.2017.1334814] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Hoa
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Y Troyanov
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Rheumatology, Sacré-Coeur Hospital, Montreal, QC, Canada
| | - MJ Fritzler
- Faculty of Medicine and Mitogen Advanced Diagnostics Laboratory, University of Calgary, Calgary, AB, Canada
| | - IN Targoff
- Department of Medicine, University of Oklahoma, Oklahoma City, OK, USA
| | - S Chartrand
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - AM Mansour
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Research Center, Sacré-Coeur Hospital Research Center, Montreal, QC, Canada
| | - E Rich
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - H Boudabbouz
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Rheumatology, Cité-de-la-Santé Hospital, Laval, QC, Canada
| | - J Bourré-Tessier
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - M Albert
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Research Center, Sacré-Coeur Hospital Research Center, Montreal, QC, Canada
| | - JR Goulet
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - M Landry
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Rheumatology, Sacré-Coeur Hospital, Montreal, QC, Canada
| | - JL Senécal
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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Okabayashi H, Ichiyasu H, Hirooka S, Akaike K, Kojima K, Jodai T, Sakamoto Y, Ideguchi H, Hamada S, Yoshida C, Hirosako S, Okamoto S, Kohrogi H. Clinical effects of direct hemoperfusion using a polymyxin B-immobilized fiber column in clinically amyopathic dermatomyositis-associated rapidly progressive interstitial pneumonias. BMC Pulm Med 2017; 17:134. [PMID: 29065861 PMCID: PMC5655872 DOI: 10.1186/s12890-017-0479-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/18/2017] [Indexed: 01/08/2023] Open
Abstract
Background Rapidly progressive interstitial pneumonias (RPIPs) associated with clinically amyopathic dermatomyositis (CADM) are highly resistant to therapy and have a poor prognosis. Multimodal therapies, including direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX-DHP), have a protective effect on RPIPs. We evaluated the effects of PMX-DHP on CADM-associated RPIPs. Methods We retrospectively enrolled 14 patients with CADM-associated RPIPs and acute respiratory failure treated with PMX-DHP, corticosteroids, and immunosuppressive agents. Clinical manifestations were compared between survivors and non-survivors at 90 days after PMX-DHP. Results The survival rate at 90 days after PMX-DHP was 35.7% (5/14). Before PMX-DHP, the survivor group exhibited a significantly higher PaO2/FiO2 (P/F) ratio and serum surfactant protein-D (SP-D) levels and significantly lower lactate dehydrogenase (LDH) and ferritin levels than the non-survivor group. Platelet counts were significantly decreased after PMX-DHP therapy in both groups, but remained higher in the survivor group than the non-survivor group over the course of treatment. Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody positive patients demonstrated a poor 90-day survival rate, lower platelet counts and P/F ratio, and higher LDH levels than anti-MDA-5 antibody negative patients. Conclusions CADM-associated RPIPs with anti-MDA-5 antibody is associated with a very poor prognosis. A higher P/F ratio and SP-D level, lower LDH and ferritin levels, higher platelet counts, and anti-MDA-5 antibody negativity are important prognostic markers in patients with CADM-associated RPIPs treated with PMX-DHP.
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Affiliation(s)
- Hiroko Okabayashi
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hidenori Ichiyasu
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Sayuri Hirooka
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kimitaka Akaike
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Keisuke Kojima
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takayuki Jodai
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasumiko Sakamoto
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideharu Ideguchi
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shohei Hamada
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Chieko Yoshida
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Susumu Hirosako
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shinichiro Okamoto
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hirotsugu Kohrogi
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Yasuda H, Ikeda T, Hamaguchi Y, Furukawa F. Clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonia: The relation between the disease activity and the serum interleukin-6 level. J Dermatol 2017; 44:1164-1167. [PMID: 28543432 DOI: 10.1111/1346-8138.13887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
Abstract
A 67-year-old woman exhibited chilblain-like erythema on the bilateral auricles, erythema with hyperkeratosis on the sides of fingers and the bilateral elbows, and erythema on the extensor/flexor sides of the finger joints and the iliac regions. Fine crackles were audible on the dorsal side of the bilateral lower lung regions. We diagnosed clinically amyopathic dermatomyositis accompanied by rapidly progressive interstitial pneumonia. While we initiated immunosuppressive therapy, the respiratory failure showed no responses. We performed endotoxin adsorption therapy using polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP). After the first PMX-DHP session, the respiratory condition was slightly improved but it soon deteriorated. At the second PMX-DHP session, subcutaneous and mediastinal emphysema was noted. The patient died, showing no improvement in the respiratory condition. We measured the levels of serum interleukin (IL)-6, tumor necrosis factor (TNF)-α and IL-10 before and after PMX-DHP and compared them with previously reported levels. The levels of TNF-α and IL-10 showed no or slight changes, but those of IL-6 at the beginning of the treatment were higher compared with previous reports. After the first PMX-DHP, the IL-6 level decreased with slight improvement in respiratory condition. However, after the second PMX-DHP, it increased markedly with exacerbation of the respiratory failure. The serum IL-6 level is considered to be effective for the evaluation of the disease activity and prognosis under the treatment by PMX-DHP.
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Affiliation(s)
- Hazuki Yasuda
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan.,Department of Dermatology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takaharu Ikeda
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
| | - Yasuhito Hamaguchi
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Fukumi Furukawa
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
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Koyama RVL, Braga TKK, da Silva Dias GA, Fujihara S, Fuzii HT, Yoshikawa GT. Hypomyopathic dermatomyositis associated with interstitial lung disease and good response to mycophenolate mofetil: case-based review. Clin Rheumatol 2017; 36:1919-1926. [DOI: 10.1007/s10067-017-3671-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 04/23/2017] [Accepted: 04/26/2017] [Indexed: 01/05/2023]
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Furusawa H, Sugiura M, Mitaka C, Inase N. Direct hemoperfusion with polymyxin B-immobilized fibre treatment for acute exacerbation of interstitial pneumonia. Respirology 2017; 22:1357-1362. [PMID: 28440556 DOI: 10.1111/resp.13054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/13/2017] [Accepted: 03/01/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is recognized as an important cause of mortality. AE has also been reported in patients with other interstitial lung diseases such as idiopathic non-specific interstitial pneumonia (NSIP) and interstitial pneumonia associated with collagen vascular disease (CVD). Current therapies such as high-dose corticosteroid with immunosuppressive agents have provided little benefit for AE. Direct hemoperfusion (DHP) with a polymyxin B-immobilized fibre column (PMX) was originally developed for the treatment of endotoxaemia. Recent clinical reports have suggested beneficial effects of PMX-DHP treatment on patients with AE. In this study, we evaluated the effectiveness and safety of PMX-DHP treatment for patients with AE. METHODS The clinical records of patients with AE admitted to our intensive care unit between 2006 and 2015 were retrospectively reviewed. RESULTS Of 54 patients with AE identified from clinical records, 24 were treated with PMX-DHP and 30 were treated without PMX-DHP. The peripheral white blood cell count was significantly decreased (P < 0.001) and the PaO2 /FiO2 (P/F) ratio was significantly improved after PMX-DHP (P = 0.032). While no significant difference was found in the survival proportion between patients treated with and without PMX-DHP, the prognosis of patients with dermatomyositis was significantly improved with the treatment (P = 0.045). Among the PMX-DHP-treated patients, those who received the treatment within 3 days of AE onset tended to have a better prognosis (P = 0.026). CONCLUSION The early induction of PMX-DHP treatment may improve the prognosis of patients with AE, especially those with dermatomyositis.
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Affiliation(s)
- Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makiko Sugiura
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chieko Mitaka
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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