From the Guidelines
The treatment for dermatomyositis should involve a combination of high-dose corticosteroids and a steroid-sparing agent, such as methotrexate, azathioprine, or mycophenolate mofetil, as the initial drug regimen, followed by a tapering course of corticosteroids, as recommended by the most recent and highest quality study 1.
Key Treatment Components
- High-dose corticosteroids, such as prednisone, starting at 0.5-1 mg/kg/day, which is maintained until symptoms improve and then gradually tapered over months 1
- Immunossuppressive medications, including methotrexate (15-25 mg weekly), azathioprine (1-3 mg/kg/day), or mycophenolate mofetil (1-3 g daily in divided doses), to reduce steroid dependence or for patients who don't respond adequately to steroids 1
- For severe or refractory cases, intravenous immunoglobulin (IVIG) at 2 g/kg divided over 2-5 days may be used monthly, or rituximab (1000 mg IV given twice, two weeks apart) may be considered as an adjunctive therapy 1
Supportive Care
- Physical therapy to maintain muscle strength and prevent contractures 1
- Sun protection, including the use of broad-spectrum sunscreen (SPF 50+), wearing protective clothing, and limiting sun exposure, as UV exposure can trigger flares 1
- Regular monitoring for disease complications, including interstitial lung disease and associated malignancies, is important as dermatomyositis is an autoimmune inflammatory myopathy that affects skin and muscles through immune-mediated processes targeting muscle fibers and blood vessels 1
From the FDA Drug Label
- Collagen Diseases During an exacerbation or as maintenance therapy in selected cases of: Systemic lupus erythematosus Systemic dermatomyositis (polymyositis)
- Treatment for Dermatomyositis: The drug label indicates that prednisone can be used as treatment for systemic dermatomyositis (polymyositis) during an exacerbation or as maintenance therapy in selected cases 2.
- Key Points:
- Prednisone is used for short-term administration to tide the patient over an acute episode or exacerbation.
- It can be used as maintenance therapy in selected cases.
From the Research
Treatment for Dermatomyositis
The treatment for dermatomyositis typically involves a combination of medications to manage the symptoms and slow the progression of the disease. Some of the treatment options include:
- Corticosteroids, such as prednisone, to reduce inflammation and suppress the immune system 3, 4, 5
- Immunosuppressive medications, such as azathioprine or methotrexate, to help reduce the immune system's attack on the muscles and skin 5
- Intravenous immunoglobulin (IVIG) to help reduce inflammation and improve muscle strength 3, 6
- Hydroxychloroquine to improve cutaneous lesions 7
- Rituximab, mycophenolate mofetil, or tacrolimus in case of treatment failure 5
Treatment Response
The response to treatment can vary depending on the individual and the severity of the disease. Some studies have shown that:
- High-dose prednisone followed by slow tapering can be effective in resolving myositis 4
- IVIG can improve muscle strength and reduce inflammation 3, 6
- Hydroxychloroquine can improve cutaneous lesions, but may not have a beneficial effect on myositis 7
Treatment Strategies
The treatment strategy for dermatomyositis often involves a combination of medications and may need to be adjusted over time. Some studies suggest that:
- Most patients require treatment with oral high-dose prednisone combined with azathioprine or methotrexate to facilitate early tapering of prednisone 5
- IVIG can be tried in case of treatment failure, followed by rituximab, mycophenolate mofetil, or tacrolimus depending on the specific clinical situation 5