Treatment options from bench to bedside for adult dermatomyositis

ABSTRACT Introduction: Current literature has minimal solid data to guide therapeutic intervention in adult dermatomyositis and studies that include systemic inflammatory mechanism suppression, musculoskeletal and extra-muscular tissue damage prevention, and comorbidities. Area covered: This systematic literature review discusses drug and non-drug treatments in patients with adult dermatomyositis. The review includes search results on the Medline (PubMed), Cochrane, and Embase databases and lonely allows available research studies published before October 2019. Expert opinion: The importance of non-drug treatments in patients with dermatomyositis has been highlighted, especially the multidisciplinary approach of minimizing damage and paying special attention to multiple possible organ and system involvement (mainly the gastrointestinal, cardiac, lung, joint, and cutaneous impairments) and comorbidities. Considering the limitations caused by muscle involvement, special attention should be given to the establishment of early exercise programs. Concerning drug treatments, glucocorticoids with intravenous human immunoglobulin could be the first-line treatment for refractory cases and/or cases where immunosuppressive/immunomodulatory drugs are contraindicated. Among immunobiological drugs, rituximab has the most evidence in the literature to support its use.