Background/Purpose: Dermatomyositis (DM) is a chronic idiopathic inflammatory myopathy with variable clinical course, but little is known regarding factors associated with remission of disease. We conducted a retrospective cohort study of 246 adult patients at Stanford to determine the rate of discontinuation of systemic immunosuppressive therapy as a proxy for clinical remission.

Methods: Inclusion criteria included patients diagnosed with DM after 18 years of age and seen for at least one clinic visit at the Stanford multidisciplinary rheumatology/dermatology clinic between January 1, 2013 to December 31, 2020. Included patients were exposed to at least one immunosuppressive medication for at least 3 months. Patients not returning to clinic were contacted via phone or email to determine status of medication use. Survival analysis was performed using Kaplan-Meier curves and log rank analyses. Variables significantly associated with medication cessation or with p-value < 0.15 on univariable analysis were used to perform multivariate analysis using Cox proportional-hazards models.

Results: 47 patients (19%) discontinued medications over a median follow-up time from disease onset of approximately 7 years. The median time to medication cessation from disease onset was approximately 3 years. Log rank analysis indicated that patients with at least one DM-specific autoantibody ceased all medication use significantly earlier than those without (p= 0.018) (Figure 1). In particular, those with anti-MDA5 autoantibodies had significantly shorter time to medication cessation compared with the negative autoantibody group (p=0.03). Multivariable modeling was performed including demographic features, specific organ involvement, and autoantibody status as covariates. Clinically amyopathic patients were 2.6-fold (CI 1.29-5.27) more likely to discontinue medications than those with muscle disease. In addition, those with anti-MDA5, anti-NXP2, and anti-SAE1 antibodies had increased likelihood of medication cessation with hazard ratios of 11.4 (CI 2.42-53.7), 12.0 (CI 2.31-62.7), and 10.2 (CI 2.07-50.3) respectively when compared to patients with no DM-specific autoantibodies.

Conclusion: We found that almost 20% of our DM cohort were able to discontinue immunosuppressive medications over the course of several years. Those with clinically amyopathic disease, anti-MDA5, anti-NXP2, and anti-SAE1 antibodies were associated with a higher likelihood of medication cessation.

Figure_1.jpeg”Factor associated with medication cessation in patients with dermatomyositis. Patients with at least one myositis specific autoantibody had a significantly shorter time to medication cessation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-impacting-likelihood-of-discontinuing-immunosuppression-in-adult-dermatomyositis-a-single-center-study/