Tocilizumab for refractory rapidly progressive interstitial lung disease related to anti-MDA5-positive dermatomyositis
Xiao Zhang, Shuang Zhou, Chanyuan Wu, Mengtao Li, Qian Wang, Yan Zhao, Xiaofeng Zeng
Abstract
Dear Editor, Anti-melanoma differentiation-associated gene 5 (MDA5)-positive DM is associated with life-threatening rapidly progressive interstitial lung disease (RP-ILD). Even after combination immunosuppressive therapy with high-dose glucocorticoid, CYC and calcineurin inhibitors, more than half of patients died within 3 months of disease onset [1, 2]. It has been reported that the serum levels of ferritin, IL-6, IL-8 and IL-10 were higher in the RP-ILD subset than in the non-ILD subset or in the chronic ILD subset [3]. Treatment targeting B cells and pro-inflammatory cytokines, such as rituximab, tofacitinib, anakinra or plasmapheresis, has shown promising effectiveness [4, 5]. Tocilizumab (TCZ) is an IL-6 receptor antagonist and has been used to treat RA and JIA. Recently it was approved for the treatment of chimeric antigen receptor T cell therapy–associated cytokine release syndrome. Herein we present six cases of anti-MDA5-positive DM complicated with RP-ILD who...