Low Probability of Skin Disease Remission in Dermatomyositis

A substantial proportion of patients with dermatomyositis (DM) have cutaneous disease that is not adequately managed with standard-of-care therapies despite long-term aggressive treatment, underscoring the need for improved therapies designed to more effectively manage skin disease among these individuals, according to the results of a recent prospective cohort study published in JAMA Dermatology.

The objective of the current study was to characterize the cutaneous disease course in adult patients with DM. All adult patients >18 years of age with DM who were seen between May 15, 2007, and October 28, 2016, at a dermatology clinic at a tertiary academic referral center were eligible for enrollment.

A total of 74 patients met inclusion criteria, including a baseline Cutaneous Dermatomyositis Disease Area and Severity Index activity score of ≥12 and ≥2 index scores separated by ≥3 months within the first 3 years of follow-up.

In multivariable analysis, increased age (odds ratio [OR], 1.07; 95% CI, 1.02-1.12; P =.01), a DM-associated malignancy (OR, 14.46; 95% CI, 2.18-96.07; P =.01), and treatment with mycophenolate mofetil (OR, 6.00; 95% CI, 1.66-21.78; P =.01) were all significantly associated with clinical remission of skin disease.

Those patients with antimelanoma differentiation-associated protein 5 antibodies had a significantly reduced likelihood of achieving clinical remission, and thus worse outcomes, during 3 years of follow-up.

Baseline cutaneous disease activity, disease duration at baseline, and disease duration before initial systemic therapy were all not significantly associated with clinical remission of skin disease. Overall, only 38% (28 of 74) of patients with DM achieved clinical skin remission during the 3-year follow-up period.

The investigators concluded that despite the use of aggressive therapy in the population of patients with DM, the achievement of clinical remission was relatively uncommon, and even less likely among those with antimelanoma differentiation-associated protein 5 antibodies.

The development of novel treatments is warranted to more successfully treat skin disease among this patient population.

Reference

Wolstencroft PW, Chung L, Li S, Casciola-Rosen L, Fiorentino DF. Factors associated with clinical remission of skin disease in dermatomyositis [published online November 7, 2017]. JAMA Dermatol. doi: 10.1001/jamadermatol.2017.3758