In adults aged 18 years or older with polymyositis, a structured next-line protocol is indicated when initial therapy does not produce the expected response. This page outlines the escalation scenario and provides access to the full evidence-based regimen.
Adults aged 18 years or older with a confirmed diagnosis of polymyositis who have completed an initial treatment course without achieving the required clinical response.
The preceding line consisted of oral prednisolone, with intravenous methylprednisolone considered where gastrointestinal absorption was a concern, combined with a disease-modifying anti-rheumatic drug — methotrexate, azathioprine, tacrolimus, ciclosporin, or mycophenolate mofetil — alongside a specialist-led exercise programme.
Trigger for escalation: Substantial improvement in disease activity across all domains was not achieved, assessed at approximately 6 weeks from treatment initiation.
For adults where initial therapy has proved insufficient, the next step may involve an intravenous agent specifically indicated for severe or refractory muscle inflammation. The complete structured regimen — covering which options apply, under what circumstances, and in what order — is available via the link below.
DOI: 10.1093/rheumatology/keac115