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. 2020 Apr 15;22(1):79.
doi: 10.1186/s13075-020-02164-5.

Retrospective analysis of infliximab and adalimumab treatment in a large cohort of juvenile dermatomyositis patients

Raquel Campanilho-Marques  1   2   3   4   5 , Claire T Deakin  1   3   6 , Stefania Simou  1 , Charalampia Papadopoulou  1   2 , Lucy R Wedderburn  1   2   3   6 , Clarissa A Pilkington  7   8 ; Juvenile Dermatomyositis Research Group (JDRG)
Collaborators, Affiliations

Retrospective analysis of infliximab and adalimumab treatment in a large cohort of juvenile dermatomyositis patients

Raquel Campanilho-Marques et al. Arthritis Res Ther. .

Abstract

Background: Anti-TNF treatment may be useful for the treatment of patients with refractory juvenile dermatomyositis (JDM). The aim of this study was to describe the use of infliximab and adalimumab therapy in juvenile dermatomyositis as an adjunctive treatment.

Methods: Sixty children recruited to the UK JDM Cohort and Biomarker Study that had received at least 3 months of anti-TNF treatment (infliximab or adalimumab) were studied. Childhood Myositis Assessment Scale (CMAS), Manual Muscle Testing (MMT8) and physician's global assessment (PGA) were recorded. Skin disease was assessed using the modified skin disease activity score (DAS). Data were analysed using Friedman's test for repeated measures analysis of variance.

Results: Compared to baseline, there were improvements at 6 and 12 months in skin disease (χ2(2) = 15.52, p = 0.00043), global disease (χ2(2) = 8.14, p = 0.017) and muscle disease (CMAS χ2(2) = 17.02, p = 0.0002 and MMT χ2(2) = 10.56, p = 0.005) in infliximab patients. For patients who switched from infliximab to adalimumab, there was improvement in global disease activity (χ2(2) = 6.73, p = 0.03), and trends towards improvement in CMAS, MMT8 and modified DAS. The median initial prednisolone dose was 6 [0-10] mg, and final was 2.5 [0-7.5] mg (p < 0.0001). Fifty-four per cent of patients had a reduction in the number and/or size of calcinosis lesions. Twenty-five per cent switched their anti-TNF treatment from infliximab to adalimumab. 66.7%of the switches were to improve disease control, 26.7% due to adverse events and 6.6% due to patient preference. A total of 13.9 adverse reactions occurred in 100 patient-years, of which 5.7 were considered serious.

Conclusion: Reductions in muscle and skin disease, including calcinosis, were seen following treatment with infliximab and adalimumab.

Keywords: Adalimumab; Biologic therapy; Infliximab; Juvenile dermatomyositis; P rheumatology.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Steroid-sparing effect of use of anti-TNF therapy. Dose of prednisolone (mg/day) at anti-TNF start and 12 months of anti-TNF treatment. n = 43 patients (number of patients with complete data available)
Fig. 2
Fig. 2
Clinical measures over time in patients treated with infliximab (total of 43 patients). Clinical outcome measures of patients on infliximab are shown at baseline (time of starting infliximab) and at 6 and 12 months of infliximab treatment. a PGA, b Modified DAS, c CMAS and d MMT. n, number of patients with available data; PGA, Physician Global Assessment; DAS, Disease Activity Score; CMAS, Childhood Myositis Assessment Scale; MMT, Manual Muscle Testing
Fig. 3
Fig. 3
Clinical measures in patients who switched from infliximab to adalimumab (total of 16 patients). Score shown at 0 (time of switch), 6 and 12 months of Adalimumab treatment. a PGA, b Modified DAS, c CMAS and d MMT. n, number of patients with available data; PGA, Physician Global Assessment; DAS, Disease Activity Score; CMAS, Childhood Myositis Assessment Scale; MMT, Manual Muscle Testing
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