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Cochrane Database of Systematic Reviews

Treatment for inclusion body myositis

Overview of attention for article published in Cochrane database of systematic reviews, June 2015
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Title
Treatment for inclusion body myositis
Published in
Cochrane database of systematic reviews, June 2015
DOI 10.1002/14651858.cd001555.pub5
Pubmed ID
Authors

Michael R Rose, Katherine Jones, Kevin Leong, Maggie C Walter, James Miller, Marinos C Dalakas, Ruth Brassington, Robert Griggs

Abstract

Inclusion body myositis (IBM) is a late-onset inflammatory muscle disease (myopathy) associated with progressive proximal and distal limb muscle atrophy and weakness. Treatment options have attempted to target inflammatory and atrophic features of this condition (for example with immunosuppressive and immunomodulating drugs, anabolic steroids, and antioxidant treatments), although as yet there is no known effective treatment for reversing or minimising the progression of inclusion body myositis. In this review we have considered the benefits, adverse effects, and costs of treatment in targeting cardinal effects of the condition, namely muscle atrophy, weakness, and functional impairment. To assess the effects of treatment for IBM. On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, and EMBASE. Additionally in November 2014 we searched clinical trials registries for ongoing or completed but unpublished trials. We considered randomised or quasi-randomised trials, including cross-over trials, of treatment for IBM in adults compared to placebo or any other treatment for inclusion in the review. We specifically excluded people with familial IBM and hereditary inclusion body myopathy, but we included people who had connective tissue and autoimmune diseases associated with IBM, which may or may not be identified in trials. We did not include studies of exercise therapy or dysphagia management, which are topics of other Cochrane systematic reviews. We used standard Cochrane methodological procedures. The review included 10 trials (249 participants) using different treatment regimens. Seven of the 10 trials assessed single agents, and 3 assessed combined agents. Many of the studies did not present adequate data for the reporting of the primary outcome of the review, which was the percentage change in muscle strength score at six months. Pooled data from two trials of interferon beta-1a (n = 58) identified no important difference in normalised manual muscle strength sum scores from baseline to six months (mean difference (MD) -0.06, 95% CI -0.15 to 0.03) between IFN beta-1a and placebo (moderate-quality evidence). A single trial of methotrexate (MTX) (n = 44) provided moderate-quality evidence that MTX did not arrest or slow disease progression, based on reported percentage change in manual muscle strength sum scores at 12 months. None of the fully published trials were adequately powered to detect a treatment effect.We assessed six of the nine fully published trials as providing very low-quality evidence in relation to the primary outcome measure. Three trials (n = 78) compared intravenous immunoglobulin (combined in one trial with prednisone) to a placebo, but we were unable to perform meta-analysis because of variations in study analysis and presentation of trial data, with no access to the primary data for re-analysis. Other comparisons were also reported in single trials. An open trial of anti-T lymphocyte immunoglobulin (ATG) combined with MTX versus MTX provided very low-quality evidence in favour of the combined therapy, based on percentage change in quantitative muscle strength sum scores at 12 months (MD 12.50%, 95% CI 2.43 to 22.57). Data from trials of oxandrolone versus placebo, azathioprine (AZA) combined with MTX versus MTX, and arimoclomol versus placebo did not allow us to report either normalised or percentage change in muscle strength sum scores. A complete analysis of the effects of arimoclomol is pending data publication. Studies of simvastatin and bimagrumab (BYM338) are ongoing.All analysed trials reported adverse events. Only 1 of the 10 trials interpreted these for statistical significance. None of the trials included prespecified criteria for significant adverse events. Trials of interferon beta-1a and MTX provided moderate-quality evidence of having no effect on the progression of sporadic inclusion body myositis. Overall trial design limitations including risk of bias, low numbers of participants, and short duration make it difficult to say whether or not any of the drug treatments included in this review were effective. An open trial of ATG combined with MTX versus MTX provided very low-quality evidence in favour of the combined therapy based on the percentage change data given. We were unable to draw conclusions from trials of IVIg, oxandrolone, and AZA plus MTX versus MTX. We need more randomised controlled trials that are larger, of longer duration, and that use fully validated, standardised, and responsive outcome measures.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 221 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
South Africa 1 <1%
Unknown 220 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 35 16%
Student > Master 26 12%
Researcher 25 11%
Student > Bachelor 22 10%
Other 12 5%
Other 36 16%
Unknown 65 29%
Readers by discipline Count As %
Medicine and Dentistry 66 30%
Nursing and Health Professions 22 10%
Psychology 13 6%
Pharmacology, Toxicology and Pharmaceutical Science 9 4%
Biochemistry, Genetics and Molecular Biology 6 3%
Other 29 13%
Unknown 76 34%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 03 July 2015.
All research outputs
#22,138,114
of 24,703,339 outputs
Outputs from Cochrane database of systematic reviews
#12,620
of 12,960 outputs
Outputs of similar age
#227,828
of 268,044 outputs
Outputs of similar age from Cochrane database of systematic reviews
#293
of 299 outputs
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So far Altmetric has tracked 12,960 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 34.9. This one is in the 1st percentile – i.e., 1% of its peers scored the same or lower than it.
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