Amato Anthony A, Griggs Robert C
Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Curr Opin Neurol. 2003 Oct;16(5):569-75. doi: 10.1097/01.wco.0000093099.34793.40.
This article reviews the results of recent therapeutic trials in dermatomyositis, polymyositis, and inclusion body myositis and suggests an approach to treating patients with inflammatory myopathy.
We reviewed 10 double-blind, placebo-controlled therapeutic trials in patients with inflammatory myopathy. Only one, using intravenous immunoglobulin in refractory dermatomyositis, indicated benefit. A brief trial of azathioprine in polymyositis and eight studies using various treatments in inclusion body myositis did not show benefit.
There have been no adequate double-blind, placebo-controlled therapeutic trials of dermatomyositis and polymyositis. It is generally accepted, however, that these disorders respond to immunosuppressive agents. Prednisone is usually the initial treatment. There is no agreement on how prednisone should be administered and even less agreement about other agents. Inclusion body myositis, which now appears to be the most common (in adults), is unresponsive to immunosuppressive and immunomodulating therapies. There are candidate treatments for inclusion body myositis and a need for additional double-blind, placebo-controlled therapeutic trials in all patients with inflammatory myopathy.
本文回顾了近期皮肌炎、多肌炎和包涵体肌炎治疗试验的结果，并提出了治疗炎性肌病患者的方法。
我们回顾了10项针对炎性肌病患者的双盲、安慰剂对照治疗试验。只有一项在难治性皮肌炎中使用静脉注射免疫球蛋白的试验显示出益处。一项在多肌炎中使用硫唑嘌呤的简短试验以及八项在包涵体肌炎中使用各种治疗方法的研究均未显示出益处。
目前尚无足够的针对皮肌炎和多肌炎的双盲、安慰剂对照治疗试验。然而，人们普遍认为这些疾病对免疫抑制剂有反应。泼尼松通常是初始治疗药物。关于泼尼松的给药方式尚无共识，对于其他药物的共识更少。包涵体肌炎目前似乎是最常见的（在成人中），对免疫抑制和免疫调节疗法无反应。有针对包涵体肌炎的候选治疗方法，并且需要对所有炎性肌病患者进行更多的双盲、安慰剂对照治疗试验。
