Suzuka Takayasu, Kotani Takuya, Takeuchi Tohru, Fujiki Youhei, Hata Kenichiro, Yoshida Shuzo, Shoda Takeshi, Makino Shigeki, Arawaka Shigeki
Department of Internal Medicine IV, Osaka Medical College, Takatsuki, Osaka, Japan.
Int J Rheum Dis. 2019 Feb;22(2):303-313. doi: 10.1111/1756-185X.13414. Epub 2018 Nov 5.
We assessed the efficacy and safety of combination therapy with glucocorticoids and high-trough level tacrolimus (TAC) for the treatment of acute/subacute interstitial pneumonia (A/SIP) in patients with dermatomyositis (DM).
Eleven DM-A/SIP patients were enrolled. The combination therapy with glucocorticoids and TAC was started as early as possible after DM-A/SIP was diagnosed. We monitored the trough concentration of TAC. In the initial 3 months, we maintained the trough concentration of TAC at relatively high levels within a range of 15-20 ng/mL. Then, we decreased the TAC doses stepwise to keep the trough concentration at 10-15 ng/mL in the next 3 months and 5-10 ng/mL as a maintenance dose.
Seven patients had clinically amyopathic DM. Six patients were positive for anti-aminoacyl-tRNA synthetase antibody and two were positive for anti-melanoma differentiation-associated gene 5 antibody. Ten patients survived for the period of the 24-week follow up. One patient died under a tentative diagnosis of viral encephalitis at 4 months after the treatment. In the 10 surviving patients, interstitial pneumonia improved in eight patients and was not worse in two patients. Clinical examinations, including the Krebs von den Lungen-6 levels, % forced vital capacity, and chest computed tomography score, were significantly improved by this combination therapy. Although grade 1 and 2 renal damage occurred in 4 and 2 patients, respectively.
The present findings suggest that early therapeutic intervention by a combination with glucocorticoids and initial high-trough level TAC is effective for DM-A/SIP although consideration of the risks of infection and renal damage is required.
我们评估了糖皮质激素与高谷浓度他克莫司（TAC）联合治疗皮肌炎（DM）患者急性/亚急性间质性肺炎（A/SIP）的疗效和安全性。
纳入11例DM-A/SIP患者。在诊断DM-A/SIP后尽早开始糖皮质激素与TAC联合治疗。我们监测TAC的谷浓度。在最初3个月，我们将TAC的谷浓度维持在15 - 20 ng/mL的相对较高水平范围内。然后，我们逐步降低TAC剂量，在接下来3个月将谷浓度维持在10 - 15 ng/mL，并将5 - 10 ng/mL作为维持剂量。
7例患者为临床无肌病性DM。6例患者抗氨酰 - tRNA合成酶抗体阳性，2例患者抗黑色素瘤分化相关基因5抗体阳性。10例患者在24周随访期内存活。1例患者在治疗后4个月因初步诊断为病毒性脑炎死亡。在10例存活患者中，8例患者间质性肺炎改善，2例患者病情未恶化。包括克雷伯斯 - 冯 - 登 - 伦根 - 6水平、用力肺活量百分比和胸部计算机断层扫描评分在内的临床检查通过这种联合治疗有显著改善。尽管分别有4例和2例患者发生1级和2级肾损害。
目前的研究结果表明，糖皮质激素与初始高谷浓度TAC联合进行早期治疗干预对DM-A/SIP有效，尽管需要考虑感染和肾损害的风险。
