How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab unresponsive to standard therapies?

How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab (and low TIF1 gamma) that failed prednisone + Cellcept, IVIG + Cellcept, Rituximab alone, methotrexate (20mg) + IVIG (2g every 4 weeks)?

Answer from: at Academic Institution

There are several questions raised by this scenario. I have personally never seen a patient with true HMGCR-antibody + necrotizing autoimmune myopathy fail a combination of 3 immunotherapies (high dose prednisone, IVIG, and either Rituximab or oral immunosuppression like Cellcept/azathioprine, etc),...

Comments

at United Regional Physician Group
Thank you for this thorough review. The patient h...

at NIAMS
There is a group at NIAMS at the NIH who are very ...

at University of Minnesota
Okay, therefore, the patient has definitely shown ...

at United Regional Physician Group
Thank you so much for all these recommendations.

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How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab unresponsive to standard therapies?

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