Comparative Effectiveness of Azathioprine Versus Cyclosporine as an Initial Treatment for Idiopathic Inflammatory Myopathies: A Population-Based Observational Study
Tóm tắt
To compare the effectiveness of azathioprine (AZA) and cyclosporine (CsA) as initial treatments for patients with idiopathic inflammatory myopathies (IIM). A retrospective cohort study was conducted using information from the National Health Insurance Service database of Republic of Korea. Patients with IIM who had started AZA or CsA as initial treatment between January 2007 and December 2011 were selected for the study. They were followed from the day of treatment initiation to the occurrence of study outcomes or the end of the study until December 2016. Effectiveness outcomes, defined as switching the drug or adding immunosuppressants, and discontinuation of corticosteroids, were compared between the two groups. The Cox proportional-hazards model was used to calculate the adjusted relative risk (aRR) with 95% confidence interval (CI) between the AZA and CsA groups. A total of 376 patients with incident IIM who used AZA (n = 288) or CsA (n = 88) were identified. The aRR of switching the drug or adding immunosuppressants (1.45 [95% CI 0.99–2.11]) was not significantly different between the CsA and AZA groups. Among patients who were treated with corticosteroids at baseline, the rate of discontinuation of corticosteroids was not different between the two groups (1.69 [95% CI 0.82–3.47]). The effectiveness of AZA and CsA as initial treatments for the management of IIM was comparable.
Tài liệu tham khảo
Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. 2003;362:971–82.
Cho S-K, Kim H, Myung J, et al. Incidence and prevalence of idiopathic inflammatory myopathies in Korea: a nationwide population-based study. J Korean Med Sci. 2019;34:e55.
Meyer A, Meyer N, Schaeffer M, et al. Incidence and prevalence of inflammatory myopathies: a systematic review. Rheumatology. 2014;54:50–63.
Dobloug GC, Svensson J, Lundberg IE, et al. Mortality in idiopathic inflammatory myopathy: results from a Swedish nationwide population-based cohort study. Ann Rheum Dis. 2018;77:40–7.
Meyer A, Scirè CA, Talarico R, et al. Idiopathic inflammatory myopathies: narrative review of unmet needs in clinical practice guidelines. RMD Open. 2019;4:e000784.
Kohsaka H, Mimori T, Kanda T, et al. Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists. Mod Rheumatol. 2019;29:1–19.
Sasaki H, Kohsaka H. Current diagnosis and treatment of polymyositis and dermatomyositis. Mod Rheumatol. 2018;28:913–21.
Saketkoo LA, Espinoza LR. Experience of mycophenolate mofetil in 10 patients with autoimmune-related interstitial lung disease demonstrates promising effects. Am J Med Sci. 2009;337:329–35.
Morganroth PA, Kreider ME, Werth VP. Mycophenolate mofetil for interstitial lung disease in dermatomyositis. Arthritis Care Res. 2010;62:1496–501.
Oddis CV, Aggarwal R. Treatment in myositis. Nat Rev Rheumatol. 2018;14:279–89.
Bunch TW. Prednisone and azathioprine for polymyositis. Long-term follow-up. Arthritis Rheum. 1981;24:45–8.
Bunch TW, Worthington JW, Combs JJ, et al. Azathioprine with prednisone for polymyositis: a controlled, clinical trial. Ann Intern Med. 1980;92:365–9.
Takada K, Kishi J, Miyasaka N. Step-up versus primary intensive approach to the treatment of interstitial pneumonia associated with dermatomyositis/polymyositis: a retrospective study. Mod Rheumatol. 2007;17:123–30.
Kotani T, Makino S, Takeuchi T, et al. Early intervention with corticosteroids and cyclosporin A and 2-hour postdose blood concentration monitoring improves the prognosis of acute/subacute interstitial pneumonia in dermatomyositis. J Rheumatol. 2008;35:254–9.
Marie I, Hatron P, Dominique S, et al. Short-term and long-term outcomes of interstitial lung disease in polymyositis and dermatomyositis: a series of 107 patients. Arthritis Rheum. 2011;63:3439–47.
Fathi M, Vikgren J, Boijsen M, et al. Interstitial lung disease in polymyositis and dermatomyositis: longitudinal evaluation by pulmonary function and radiology. Arthritis Care Res. 2008;59:677–85.
In Seol Y, Jinhyun K. The role of autoantibodies in idiopathic inflammatory myopathies. J Rheum Dis. 2019;26:165–78.
National Health Insurance Corporation HIPRI. Research report on health care utilization of patients with rare and intractable disorder and improvement of individual copayment beneficiaries program for rare and intractable disorder (in Korean). 2010. https://www.nhis.or.kr/static/html/wbd/g/a/wbdga0405.html.
Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975;292:344–7.
Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975;292:403–7.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–9.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.
Nzeusseu A, Brion F, Lefèbvre C, et al. Functional outcome of myositis patients: can a low-dose glucocorticoid regimen achieve good functional results? Clin Exp Rheumatol. 1999;17:441–6.
Villalba L, Hicks JE, Adams EM, et al. Treatment of refractory myositis: a randomized crossover study of two new cytotoxic regimens. Arthritis Rheum. 1998;41:392–9.
Oddis CV. Update on the pharmacological treatment of adult myositis. J Intern Med. 2016;280:63–74.
Newman ED, Scott DW. The use of low-dose oral methotrexate in the treatment of polymyositis and dermatomyositis. J Clin Rheumatol. 1995;1:99–102.
Miller LC, Sisson BA, Tucker LB, et al. Methotrexate treatment of recalcitrant childhood dermatomyositis. Arthritis Rheum. 1992;35:1143–9.
Miller J, Walsh Y, Saminaden S, et al., editors. Randomised double blind trial of methotrexate and steroids compared with azathioprine and steriods in the treatment of idiopathic inflammatory myopathy. J Neurol Sci. 2002: Elsevier Science BV, Amsterdam.
Vencovsky J. Cyclosporine A versus methotrexate in the treatment of polymyositis and dermatomyositis. Scand J Rheumatol. 2000;29:95–102.
Sunderkötter C, Nast A, Worm M, et al. Guidelines on dermatomyositis—excerpt from the interdisciplinary S2k guidelines on myositis syndromes by the German Society of Neurology. JDDG Journal der Deutschen Dermatologischen Gesellschaft. 2016;14:321–38.
Bellutti Enders F, Bader-Meunier B, Baildam E, et al. Consensus-based recommendations for the management of juvenile dermatomyositis. Ann Rheum Dis. 2017;76:329–40.
Singh S, Heien HC, Sangaralingham LR, et al. Comparative effectiveness and safety of infliximab and adalimumab in patients with ulcerative colitis. Aliment Pharmacol Ther. 2016;43:994–1003.
Argolini LM, Frontini G, Elefante E, et al. Multicentric study comparing cyclosporine, mycophenolate mofetil and azathioprine in the maintenance therapy of lupus nephritis: 8 years follow up. J Nephrol. 2021;34(2):389–98. https://doi.org/10.1007/s40620-020-00753-w.