Promising Avenues in Myositis: Research Targets Disease Specificity

Get Your Patients to Move
Dr. Chinoy also highlighted the importance of exercise, which he said has been shown to be safe in myositis.

“We should be starting—ideally—supervised resistance training in combination with aerobic exercise, starting four weeks after initiation of treatment or as soon as the patients are able to start exercising,” he said.

One recent study found that endurance exercise altered 39 microRNAs in myositis patients compared with controls, including changes associated with decreased immune responses and increased mitochondrial biogenesis—both of which would be expected to improve disease.⁶

Final Thoughts
Treating myositis remains a challenge not only because of the lack of approved therapies, but because of overlap clinically with other diseases.

“Patients can present with interstitial lung disease, with malignancy, with arthritis,” Dr. Chinoy said. “The whole thing can be quite confusing. … The first challenge is to try to get the correct diagnosis.”

Beyond that, he said, “It’s important that we adopt a multidisciplinary approach tailored to disease activity to serotype to phenotype. At the end of the day, we want to improve muscle strength, we want to suppress extramuscular manifestations, and we want to minimize any risk of complications.”

Dr. Chinoy said he is encouraged by recent developments in the field. “All in all, these are exciting times in myositis.”

Thomas R. Collins is a freelance writer living in South Florida.

References

1. Mendell JR, Sahenk Z, Al-Zaidy S, et al. Follistatin gene therapy for sporadic inclusion body myositis improves functional outcomes. Mol Ther. 2017 Apr 5;25(4):870–879.
2. Amato AA, Badrising U, Benveniste O, et al. A randomized, double-blind, placebo-controlled study of bimagrumab in patients with sporadic inclusion body myositis [abstract]. Arthritis Rheumatol. 2016;68(suppl 10).
3. Benveniste O, Hogrel JY, Annoussamy M, et al. Rapamycin vs. placebo for the treatment of inclusion body myositis: Improvement of the 6 min walking distance, a functional scale, the FVC and muscle quantitative MRI [abstract]. Arthritis Rheumatol. 2017;69(suppl 10).
4. Werth VP, Hejazi E, Pena SM, et al. A phase 2 study of safety and efficacy of anabasum (JBT-101), a cannabinoid receptor type 2 agonist, in refractory skin-predominant dermatomyositis [abstract]. Arthritis Rheumatol. 2017;69(suppl 10).
5. Aggarwal R, Marder G, Koontz DC, et al. Efficacy and safety of adrenocorticotropic hormone gel in refractory dermatomyositis and polymyositis. Ann Rheum Dis. 2018 May;77(5):720–727.
6. Boehler JF, Hogarth MW, Barberio MD, et al. Effect of endurance exercise on microRNAs in myositis skeletal muscle—A randomized controlled study. PLoS One. 2017 Aug 22;12(8):e0183292.