Rituximab and other biologic agents should be reserved for treating recalcitrant disease until more evidence shows otherwise.

Rituximab has been used in open-label case series and individual cases for patients with inflammatory myopathy who are refractory to standard therapies including systemic corticosteroids and immunosuppressive agents. The cases and series have primarily included adults. The effect on myopathy has been the primary outcome measure for most observations, and although some reports document improvement of skin disease, many reports suggest that skin disease is not dramatically affected. Little information is available on rituximab's effects in children or on its effectiveness for calcinosis, which more frequently complicates dermatomyositis (DM).


These authors retrospectively analyzed results of rituximab treatment in nine patients with juvenile DM. The dosing regimens varied by patient. Three of the six evaluable patients experienced a complete response in both the skin and the muscle disease. Calcinosis (in 6 patients) did not respond to rituximab, and infections occurred in the calcinosis during therapy in two patients. However, all patients were receiving additional immunosuppressive therapies in addition to rituximab. The authors conclude that rituximab might be effective for the treatment of juvenile DM in some patients and that the safety profile was good.


Citation(s):

Bader-Meunier B et al. Safety and efficacy of rituximab in severe juvenile dermatomyositis: Results from 9 patients from the French Autoimmunity and Rituximab registry. J Rheumatol 2011 Jul; 38:1436.