Study reveals that differences in drug administration may affect disease outcome in patients with JDM

April 5, 2008 — Lauren M. Pachman, MD, and colleagues have published a study that shows a difference in absorption of a drug administered to juvenile dermatomyositis (JDM) patients when given orally as opposed to intravenously. More aggressive therapies for JDM have been linked to improved outcomes in patients.

The hallmark of JDM, the most common autoimmune muscle disease of children, is destruction of capillaries, documented by counting the capillaries at the finger nail base. The study, published in the February issue of Arthritis Care & Research, shows that loss of capillaries is directly associated with decreased absorption of orally administered prednisone, the drug of choice to treat JDM, compared with the same dose of steroid given intravenously. This study provides the evidence that steroids may need to be given intravenously to the child with JDM and capillary loss in order to achieve disease control.

Says Dr. Pachman: "This finding is of importance, because it shows that a sick child with JDM and loss of capillaries may not absorb prednisone effectively when given by mouth. It provides evidence for physicians and parents, who may wish to spare the sick child from having the steroids given by the intravenous route, as well as evidence for insurance companies, which may balk at this more expensive route of administration. There is much more work that is needed in this area, so that we will be able to personalize the total dose and type of treatment for each child."

Kelly Rouster-Stevens, MD, PharmD, Assistant Professor of Pediatrics at Wake Forest University Baptist Medical Center, was first author on the study. Dr. Pachman is Professor of Pediatrics at Northwestern University's Feinberg School of Medicine, an attending physician in the Division of Rheumatology at Children's Memorial Hospital and director of the Molecular and Cellular Pathobiology Program at Children's Memorial Research Center. The study was supported by the National Center for Research Resources, NIH (grant M01-RR-0048). Drs. Rouster-Stevens and Pachman’s work was supported by The Cure Juvenile Myositis Foundation.

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