Long-term effects of early pulse methylprednisolone and intravenous immunoglobulin in patients with dermatomyositis and polymyositis.

Abstract

OBJECTIVE\nTo evaluate the long-term effects of pulse intravenous methylprednisolone (IVMP) or intravenous immunoglobulin (IVIG) administered during the first year of diagnosis in dermatomyositis (DM) and polymyositis (PM) patients.\n\n\nMETHODS\nThis is a retrospective single-center cohort study of patients with DM/PM followed for up to 4\u2009years from 2001 to 2017. We used Cox regression models to estimate hazard ratios (HRs) and assess the effects of early pulse IVMP or IVIG on 3 outcomes: complete clinical response, corticosteroid discontinuation, and survival. Analysis was adjusted for clinical, laboratory, and treatment covariates.\n\n\nRESULTS\nA total of 204 patients were included and categorized into 4 initial treatment groups: pulse IVMP (n\u2009=\u200946), pulse IVMP+IVIG (n\u2009=\u200955), IVIG (n\u2009=\u200910), and without IVMP or IVIG (n\u2009=\u200993). The groups of early pulse IVMP and pulse IVMP+IVIG had a higher HR for complete clinical response in the multivariate models (HR\u2009=\u20091.56, 95% CI\u2009=\u20091.05-2.33, p\u2009=\u20090.029; and HR\u2009=\u20091.58, 95% CI\u2009=\u20091.02-2.45, p\u2009=\u20090.041, respectively). Only the group of pulse IVMP+IVIG had a significant association with corticosteroid discontinuation in the multivariate analysis (HR\u2009=\u20091.65, 95% CI\u2009=\u20091.02-2.68, p\u2009=\u20090.043). Early pulse IVMP or IVIG had no impact on mortality.\n\n\nCONCLUSION\nDespite having a more severe disease profile, patients with DM/PM submitted to pulse IVMP or pulse IVMP+IVIG during the first year of diagnosis had a higher HR for complete clinical response, whereas the combination of pulse IVMP+IVIG had an association with corticosteroid discontinuation. Prospective long-term studies are warranted to confirm these benefits of early pulse IVMP and IVIG on patients with DM/PM.