Use of etanercept in the treatment of dermatomyositis: a case series

Objective. To evaluate the efficacy of etanercept, a recombinant human soluble fusion protein of tumor necrosis factor-a (TNF-a) type II receptor and IgG1, in patients with adult dermatomyositis (DM). Methods. Five patients with active DM were studied. All patients reported muscle weakness and had elevated muscle enzymes creatine kinase and lactate dehydrogenase. Because of lack of response to steroid and cytotoxic therapy, etanercept was given at a dose of 25 mg subcutaneously twice a week for at least 3 months. Results. All patients experienced an exacerbation of disease, with increase of muscle weakness, elevation of muscle enzyme levels, and unchanged rash. Treatment with etanercept was stopped. After receiving a combination of methotrexate (MTX) and azathioprine, disease manifestations improved in all patients. Conclusions. In our case series, TNF-a inhibition by etanercept was not effective, suggesting that a broad immunosuppressive therapy is needed to treat DM.