Open AccessCyclophosphamide Versus Obinutuzumab for the Treatment of Anti-MDA5 Positive Inflammatory Myopathy with Interstitial Lung Disease: A Study Protocol and Literature Review
Author(s) -
Ho So,
Chi Chiu Mok
Publication year - 2019
Publication title -
journal of clinical rheumatology and immunology
Language(s) - English
Resource type - Journals
eISSN - 2661-3425
pISSN - 2661-3417
DOI - 10.1142/s2661341719300040
Subject(s) - medicine , interstitial lung disease , obinutuzumab , dermatomyositis , cyclophosphamide , exacerbation , oncology , lung , rituximab , chemotherapy , lymphoma
In patients with idiopathic inflammatory myopathy, the presence of the melanoma differentiation-associated gene 5 (MDA5) antibody carries an extremely poor prognosis as a result of the associated interstitial lung disease (ILD) that is often rapidly progressive and refractory to therapies. Management of anti-MDA5 associated ILD is a challenging task as there is a paucity of clinical data and treatment guidelines in the literature. We hereby describe a proposed protocol for a multicenter randomized controlled trial to compare the efficacy of intravenous cyclophosphamide and obinutuzumab in combination with high-dose glucocorticoids and tacrolimus in terms of mortality at six months (primary outcome). The epidemiology, pathogenesis and treatment options of anti-MDA5 associated ILD are briefly reviewed.