Cyclosporin A in the treatment of refractory adult polymyositis/dermatomyositis: population based experience in 6 patients and literature review.
Bibliographic record
Abstract
OBJECTIVE: To evaluate the efficacy and toxicity of cyclosporin A (CSA) in the treatment of refractory adult polymyositis/dermatomyositis (PM/DM). METHODS: The province-wide British Columbia database for CSA use for persons with rheumatic diseases at Mary Pack Arthritis Centre was reviewed to identify all patients with PM/DM for the period January 1991 through June 1998. Also, a Medline search of English language literature was conducted for this topic from 1976 until January 1999, using the terms dermatomyositis, polymyositis, inflammatory myopathy, and cyclosporin A, and the reference lists of all papers were screened to include articles not identified by the Medline search. RESULTS: In British Columbia, 172 CSA users of whom 6 had PM/DM were identified (4 PM, 2 DM). Previous therapy included high dose prednisone (N = 6), methotrexate (N = 4), azathioprine (N = 4), intravenous immunoglobulin (N = 3), and cyclophosphamide (N = 3). The mean CSA dose was 3.5 mg/kg/day. All patients improved. Creatinine kinase (CK) levels declined 52% from baseline. All 6 patients continued CSA a median of 6 months (range 3-44 mo) after initiation of therapy. Toxicity included an increase in serum creatinine > 30% of baseline in 3 patients and hypertension in one patient. The literature review identified an additional 59 cases. Forty-eight (81%) had a reduction in CK levels and improved clinically, 9/59 (15%) developed nephrotoxicity, 5/59 (8%) hypertension responsive to dose reduction, and 9/59 (15%) had hypertrichosis, gingival hyperplasia, or tremor. CONCLUSION: Our population based experience with 6 patients and the 59 published cases suggests CSA is an effective therapy for resistant PM/DM, and toxicity is possibly more than expected in other rheumatic diseases.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".