Cyclophosphamide Versus Obinutuzumab for the Treatment of Anti-MDA5 Positive Inflammatory Myopathy with Interstitial Lung Disease: A Study Protocol and Literature Review

• Main Authors: Ho So, Chi Chiu Mok
• Format: Article
• Language: English
• Published: World Scientific Publishing 2019-12-01
• Series: Journal of Clinical Rheumatology and Immunology
• Subjects: mda5; inflammatory myopathy; interstitial; anti-cd20; biologics
• Online Access: http://www.worldscientific.com/doi/epdf/10.1142/S2661341719300040

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.