Factors associated with clinical remission of skin disease in dermatomyositis

Paige W. Wolstencroft, Lorinda Chung, Shufeng Li, Livia A Casciola Rosen, David F. Fiorentino

Research output: Contribution to journalArticle

Abstract

IMPORTANCE Cutaneous disease represents a significant burden for patients with dermatomyositis. However, quantitative estimates of the probability of skin disease remission and clinical factors associated with skin outcomes are lacking. OBJECTIVE To characterize cutaneous disease course in adult patients with dermatomyositis. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study conducted at a dermatology clinic at a tertiary academic referral center. All adult patients with dermatomyositis (age >18 years) seen between May 15, 2007, and October 28, 2016, were eligible. Patients were included in the current analysis if they had a baseline Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) activity score of 12 or higher, and 2 or more CDASI scores separated by 3 months or more within their first 3 years of follow-up. MAIN OUTCOMES AND MEASURES The percentage of patients who achieved clinical remission of their cutaneous disease as measured by the CDASI over a 3-year follow-up. RESULTS A total of 74 patients met our inclusion criteria (mean [SD] age at initial CDASI scoring, 54 [13] years; 58 women [78%]), and 28 (38%) achieved clinical remission during our 3-year follow-up period. Increased age (odds ratio [OR], 1.07; 95%CI, 1.02-1.12; P = .01), a dermatomyositis-associated malignancy (OR, 14.46; 95%CI, 2.18-96.07; P = .01), and treatment withmycophenolate mofetil (OR, 6.00; 95%CI, 1.66-21.78; P = .01) were significantly associated with clinical remission of skin disease in multivariable analysis. Patients with anti-melanoma differentiation-associated protein 5 antibodies had a significantly lower probability of meeting outcome criteria in our time-to-event analysis. Baseline cutaneous disease activity, disease duration at baseline, and disease duration before first systemic therapy were not significantly associated with clinical remission of skin disease. CONCLUSIONS AND RELEVANCE Clinical remission was relatively uncommon in our population despite aggressive systemic therapy, and patients with anti-melanoma differentiationassociated protein 5 antibodies were even less likely to enter clinical remission during a 3-year follow-up period. Althoughmycophenolate mofetil compared favorably with other treatment options, our data provide evidence that a substantial population of patients with dermatomyositis have skin disease that is not adequately managed with standard-of-care therapies.

Original languageEnglish (US)
Pages (from-to)44-51
Number of pages8
JournalJAMA Dermatology
Volume154
Issue number1
DOIs
StatePublished - Jan 1 2018

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Dermatomyositis
Skin Diseases
Odds Ratio
Therapeutics
Antibodies
Standard of Care
Dermatology
Tertiary Care Centers
Population
Melanoma
Cohort Studies

ASJC Scopus subject areas

  • Dermatology

Cite this

Factors associated with clinical remission of skin disease in dermatomyositis. / Wolstencroft, Paige W.; Chung, Lorinda; Li, Shufeng; Casciola Rosen, Livia A; Fiorentino, David F.

In: JAMA Dermatology, Vol. 154, No. 1, 01.01.2018, p. 44-51.

Research output: Contribution to journalArticle

Wolstencroft, Paige W. ; Chung, Lorinda ; Li, Shufeng ; Casciola Rosen, Livia A ; Fiorentino, David F. / Factors associated with clinical remission of skin disease in dermatomyositis. In: JAMA Dermatology. 2018 ; Vol. 154, No. 1. pp. 44-51.
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abstract = "IMPORTANCE Cutaneous disease represents a significant burden for patients with dermatomyositis. However, quantitative estimates of the probability of skin disease remission and clinical factors associated with skin outcomes are lacking. OBJECTIVE To characterize cutaneous disease course in adult patients with dermatomyositis. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study conducted at a dermatology clinic at a tertiary academic referral center. All adult patients with dermatomyositis (age >18 years) seen between May 15, 2007, and October 28, 2016, were eligible. Patients were included in the current analysis if they had a baseline Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) activity score of 12 or higher, and 2 or more CDASI scores separated by 3 months or more within their first 3 years of follow-up. MAIN OUTCOMES AND MEASURES The percentage of patients who achieved clinical remission of their cutaneous disease as measured by the CDASI over a 3-year follow-up. RESULTS A total of 74 patients met our inclusion criteria (mean [SD] age at initial CDASI scoring, 54 [13] years; 58 women [78{\%}]), and 28 (38{\%}) achieved clinical remission during our 3-year follow-up period. Increased age (odds ratio [OR], 1.07; 95{\%}CI, 1.02-1.12; P = .01), a dermatomyositis-associated malignancy (OR, 14.46; 95{\%}CI, 2.18-96.07; P = .01), and treatment withmycophenolate mofetil (OR, 6.00; 95{\%}CI, 1.66-21.78; P = .01) were significantly associated with clinical remission of skin disease in multivariable analysis. Patients with anti-melanoma differentiation-associated protein 5 antibodies had a significantly lower probability of meeting outcome criteria in our time-to-event analysis. Baseline cutaneous disease activity, disease duration at baseline, and disease duration before first systemic therapy were not significantly associated with clinical remission of skin disease. CONCLUSIONS AND RELEVANCE Clinical remission was relatively uncommon in our population despite aggressive systemic therapy, and patients with anti-melanoma differentiationassociated protein 5 antibodies were even less likely to enter clinical remission during a 3-year follow-up period. Althoughmycophenolate mofetil compared favorably with other treatment options, our data provide evidence that a substantial population of patients with dermatomyositis have skin disease that is not adequately managed with standard-of-care therapies.",
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AU - Fiorentino, David F.

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N2 - IMPORTANCE Cutaneous disease represents a significant burden for patients with dermatomyositis. However, quantitative estimates of the probability of skin disease remission and clinical factors associated with skin outcomes are lacking. OBJECTIVE To characterize cutaneous disease course in adult patients with dermatomyositis. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study conducted at a dermatology clinic at a tertiary academic referral center. All adult patients with dermatomyositis (age >18 years) seen between May 15, 2007, and October 28, 2016, were eligible. Patients were included in the current analysis if they had a baseline Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) activity score of 12 or higher, and 2 or more CDASI scores separated by 3 months or more within their first 3 years of follow-up. MAIN OUTCOMES AND MEASURES The percentage of patients who achieved clinical remission of their cutaneous disease as measured by the CDASI over a 3-year follow-up. RESULTS A total of 74 patients met our inclusion criteria (mean [SD] age at initial CDASI scoring, 54 [13] years; 58 women [78%]), and 28 (38%) achieved clinical remission during our 3-year follow-up period. Increased age (odds ratio [OR], 1.07; 95%CI, 1.02-1.12; P = .01), a dermatomyositis-associated malignancy (OR, 14.46; 95%CI, 2.18-96.07; P = .01), and treatment withmycophenolate mofetil (OR, 6.00; 95%CI, 1.66-21.78; P = .01) were significantly associated with clinical remission of skin disease in multivariable analysis. Patients with anti-melanoma differentiation-associated protein 5 antibodies had a significantly lower probability of meeting outcome criteria in our time-to-event analysis. Baseline cutaneous disease activity, disease duration at baseline, and disease duration before first systemic therapy were not significantly associated with clinical remission of skin disease. CONCLUSIONS AND RELEVANCE Clinical remission was relatively uncommon in our population despite aggressive systemic therapy, and patients with anti-melanoma differentiationassociated protein 5 antibodies were even less likely to enter clinical remission during a 3-year follow-up period. Althoughmycophenolate mofetil compared favorably with other treatment options, our data provide evidence that a substantial population of patients with dermatomyositis have skin disease that is not adequately managed with standard-of-care therapies.

AB - IMPORTANCE Cutaneous disease represents a significant burden for patients with dermatomyositis. However, quantitative estimates of the probability of skin disease remission and clinical factors associated with skin outcomes are lacking. OBJECTIVE To characterize cutaneous disease course in adult patients with dermatomyositis. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study conducted at a dermatology clinic at a tertiary academic referral center. All adult patients with dermatomyositis (age >18 years) seen between May 15, 2007, and October 28, 2016, were eligible. Patients were included in the current analysis if they had a baseline Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) activity score of 12 or higher, and 2 or more CDASI scores separated by 3 months or more within their first 3 years of follow-up. MAIN OUTCOMES AND MEASURES The percentage of patients who achieved clinical remission of their cutaneous disease as measured by the CDASI over a 3-year follow-up. RESULTS A total of 74 patients met our inclusion criteria (mean [SD] age at initial CDASI scoring, 54 [13] years; 58 women [78%]), and 28 (38%) achieved clinical remission during our 3-year follow-up period. Increased age (odds ratio [OR], 1.07; 95%CI, 1.02-1.12; P = .01), a dermatomyositis-associated malignancy (OR, 14.46; 95%CI, 2.18-96.07; P = .01), and treatment withmycophenolate mofetil (OR, 6.00; 95%CI, 1.66-21.78; P = .01) were significantly associated with clinical remission of skin disease in multivariable analysis. Patients with anti-melanoma differentiation-associated protein 5 antibodies had a significantly lower probability of meeting outcome criteria in our time-to-event analysis. Baseline cutaneous disease activity, disease duration at baseline, and disease duration before first systemic therapy were not significantly associated with clinical remission of skin disease. CONCLUSIONS AND RELEVANCE Clinical remission was relatively uncommon in our population despite aggressive systemic therapy, and patients with anti-melanoma differentiationassociated protein 5 antibodies were even less likely to enter clinical remission during a 3-year follow-up period. Althoughmycophenolate mofetil compared favorably with other treatment options, our data provide evidence that a substantial population of patients with dermatomyositis have skin disease that is not adequately managed with standard-of-care therapies.

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