Team: PRODERM, aka the “Dermato Dunks”

Base Article: PRODERM trial. Aggarwal R, et al. Trial of Intravenous Immune Globulin in Dermatomyositis. N Engl J Med. 2022 Oct 6;387(14):1264-1278. PMID: 36198179.

Authors: Medical College of Wisconsin Fellowship Program

1. Bonit Gill DO, first year rheumatology fellow, Medical College of Wisconsin
2. Mahum Mirza DO, first year rheumatology fellow, Medical College of Wisconsin
3. Rohan Mehta DO, second year rheumatology fellow, Medical College of Wisconsin
4. Desh Nepal MD, second year rheumatology fellow, Medical College of Wisconsin
5. Michael Putman, MD, MSCI, Assistant Professor, Associate Rheumatology Fellowship Program Director, Medical College of Wisconsin

Team Overview

It’s not every day a drug comes in and shakes up our Rheumatology world! Albeit a rare disease, Dermatomyositis can wreak havoc on the immune system, and can lead to progressive weakness and diffuse rashes.  Dermatomyositis has been historically treated with steroids and DMARDs for many years but it’s time for a new player on the roster. The PRODERM trial shows the efficacy of IVIG in adults with Dermatomyositis. Although IVIG had been used off label in the past, this is the first study done to confirm its worth.

95 patients aged 18 to 80 years old with active Dermatomyositis, on a maximum dose of 20 mg of Prednisone and no more than two other DMARDs, were given either IVIG or placebo every 4 weeks for 4 cycles. By using a primary end point of a Total Improvement Score (TIS) of 20, it was seen that significantly more patients treated with IVIG improved (79%) compared with placebo (44%).

The PRODERM trial proves IVIG has what it takes to go from benchwarmer to the starting lineup. To say this is a game changer in practice is an understatement. Due to this study, Rheumatologists are much more inclined to offer IVIG at the time of Dermatomyositis diagnosis. The confirmation of IVIG’s efficacy rounds out an all-star treatment regimen for the syndrome. IVIG, which was once used as a 2^nd or 3^rd line agent, is now our number one draft pick. In patients with Dermatomyositis, there is no question IVIG is a slam dunk treatment choice.

Want to learn more?

See the Q&A on theMednet.org about the following question: How will you sequence therapies in dermatomyositis given the results of the ProDERM trial?

Next Report: INBUILD

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