Which immunosuppressant is commonly used as a second-line therapy for polymyositis after corticosteroids?

Which immunosuppressant is commonly used as a second-line therapy for polymyositis after corticosteroids?

• A. Azathioprine
• B. IVIG
• C. Methotrexate
• D. Prednisone

Answer: (C)

In polymyositis, starting with corticosteroids to control inflammation is common, and once you’ve achieved initial control you often add a second agent to spare steroids and sustain improvement. Methotrexate is the most common choice for that role because it has strong, well-established evidence showing it helps improve muscle strength and decrease inflammatory activity in polymyositis and related conditions. It works as a disease-modifying immunosuppressant by dampening lymphocyte activity, and it pairs well with steroids to allow tapering of the steroid dose over time. The regimen is typically weekly, with folate supplementation to reduce some side effects, and it requires regular monitoring of liver function and blood counts. While other options exist, methotrexate generally offers a good balance of efficacy and practicality as a second-line agent; azathioprine is also used but may have less consistent data in this specific condition; IVIG is often reserved for refractory cases or when rapid improvement is needed; prednisone itself is a corticosteroid and not a second-line choice after steroids.

In polymyositis, starting with corticosteroids to control inflammation is common, and once you’ve achieved initial control you often add a second agent to spare steroids and sustain improvement. Methotrexate is the most common choice for that role because it has strong, well-established evidence showing it helps improve muscle strength and decrease inflammatory activity in polymyositis and related conditions. It works as a disease-modifying immunosuppressant by dampening lymphocyte activity, and it pairs well with steroids to allow tapering of the steroid dose over time. The regimen is typically weekly, with folate supplementation to reduce some side effects, and it requires regular monitoring of liver function and blood counts. While other options exist, methotrexate generally offers a good balance of efficacy and practicality as a second-line agent; azathioprine is also used but may have less consistent data in this specific condition; IVIG is often reserved for refractory cases or when rapid improvement is needed; prednisone itself is a corticosteroid and not a second-line choice after steroids.