Immunomodulatory drugs for idiopathic inflammatory myopathies (excluding inclusion body myositis)
Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are often used for their corticosteroid-sparing effects and to achieve remission of disease. For idiopathic inflammatory myopathies, the csDMARDs most commonly used are azathioprine, methotrexate, mycophenolate and ciclosporinPipitone, 2020.
The usual dose of azathioprine for idiopathic inflammatory myopathy is:
azathioprine 1.5 to 2.5 mg/kg orally, daily. azathioprine azathioprine azathioprine
For additional considerations specific to azathioprine use, see Specific considerations for use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).
The usual dose of methotrexate for idiopathic inflammatory myopathy is:
1methotrexate 10 to 25 mg orally, on one specified day once weekly methotrexate methotrexate methotrexate
OR
1methotrexate 10 to 25 mg subcutaneously, on one specified day once weekly methotrexate methotrexate methotrexate
PLUS with either of the above
folic acid 5 to 10 mg orally, weekly (not on the same day as methotrexate). folic acid folic acid folic acid
For additional considerations specific to methotrexate use, see Specific considerations for use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).
The usual doses of mycophenolate for idiopathic inflammatory myopathy are:
1mycophenolate mofetil 500 mg orally, twice daily; increase the dose gradually as tolerated aiming for 1000 to 1500 mg orally, twice daily (maximum 3000 mg daily)1 mycophenolate mofetil mycophenolate mofetil mycophenolate mofetil
OR
1mycophenolate sodium 360 mg orally, twice daily; increase the dose gradually as tolerated to a maximum of 1080 mg orally, twice daily. mycophenolate sodium mycophenolate sodium (mycophenolic acid) mycophenolate sodium (mycophenolic acid)
For additional considerations specific to mycophenolate use, see Specific considerations for use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).
The usual dose of ciclosporin for idiopathic inflammatory myopathy is:
ciclosporin 2.5 to 5 mg/kg orally, daily. ciclosporin ciclosporin ciclosporin
For additional considerations specific to ciclosporin use, see Specific considerations for use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).