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Abstract Number: 2980

Calcineurin Inhibitor for the Treatment of Myositis-Associated Interstitial Lung Disease: Comparison between Cyclosporine and Tacrolimus

Takahisa Gono1, Kenichi Masui2, Naoshi Nishina3, Shinji Sato4 and Masataka Kuwana1, 1Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan, 2Department of Anesthesiology, Show University Hospital, Tokyo, Japan, 3Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan, 4Division of Rheumatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Lung Disease, Myositis, outcomes and treatment options

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Session Information

Date: Wednesday, October 24, 2018

Session Title: 6W022 ACR Abstract: Muscle Biology, Myositis & Myopathies II: Clinical & Misc Topics (2976–2981)

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose: Treatment options for myositis-associated interstitial lung disease (ILD) include corticosteroids (CS) in combination with or without cyclophosphamide (CY), calcineurin inhibitors (CNIs) such as cyclosporine (CyA) and tacrolimus (TAC), mycophenolate mofetil, and/or rituximab. However, efficacy of individual treatment regimens has never been compared in randomized clinical trials, and treatment decision is made based on expertise of physicians. We have recently launched the multicenter retrospective cohort of Japanese Patients with Myositis-associated ILD (JAMI), which involved 497 incident cases of adult myositis-associated ILD from 44 institutions across Japan. By taking advantage of our large-scale cohort database, we investigated the efficacy of CNIs in myositis-associated ILD.

Methods: A total of 491 patients with adult-onset PM/DM were selected from the JAMI database. Clinical characteristics and survival rates were compared between the patient groups, followed by additional comparisons using propensity score matching method. Survival rates were calculated by the Kaplan-Meier method.

Results: The mean age at disease onset was 56, 67% were female, and median disease duration was 2 months. In a crude analysis, cumulative survival rate was significantly lower in 402 patients treated with regimens including CNI than in 89 patients treated with regimens without CNI (P = 0.03; Figure 1A). Clinical characteristics associated with CNI use included positive anti-MDA5, shorter disease duration, higher levels of CRP and ferritin, lower oxygen saturation, and more intensive immunosuppressive regimens. After matching patientsf background using propensity score, there was a trend toward a better survival rate in patients treated with CNI than in those without (Figure 1B). When we further examined efficacy between 201 patients treated with CyA and 187 patients with TAC, treatment with TAC was associated with a better survival rate, compared with CyA treatment, in a crude analysis (P = 0.02). After matching patientsf background using propensity score, the survival rates were similar between patients treated with CyA and TAC. The patients treated with CNIs were further divided into 4 subgroups according to main components contributing to the propensity score, including anti-MDA5, CRP, ferritin, and disease duration at diagnosis, there was no difference of survival rates between CyA-treated and TAC-treated patients in each subgroup (Figure 2).

Conclusion: Our results suggest potential efficacy of CNI, either CyA or TAC, in combination with CS-based regimens for broad spectrum of myositis-associated ILD.


Disclosure: T. Gono, Astellas Pharma, 8; K. Masui, None; N. Nishina, None; S. Sato, Medical & Biological Laboratorries Co., LTD, 7; M. Kuwana, Astellas, 2,MBL, 7,Astellas, Japan Blood Products Organization, 8.

To cite this abstract in AMA style:

Gono T, Masui K, Nishina N, Sato S, Kuwana M. Calcineurin Inhibitor for the Treatment of Myositis-Associated Interstitial Lung Disease: Comparison between Cyclosporine and Tacrolimus [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/calcineurin-inhibitor-for-the-treatment-of-myositis-associated-interstitial-lung-disease-comparison-between-cyclosporine-and-tacrolimus/. Accessed April 11, 2021.
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