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Multiple medications, including oncologic agents, were associated with drug-induced dermatomyositis (DM) according to a systematic review in .

Symptoms of drug-induced DM are similar to those of idiopathic DM. Typical features include rash, Gottron papules, nail telangiectasia, photosensitivity, and macular violaceous erythema.

Investigators ultimately identified 134 studies for inclusion in the review, collectively describing 165 cases. Of the patients analyzed, 88 (53.3%) were female with a median age of 61. Medications most commonly associated with drug-induced DM were hydroxyurea, immune checkpoint inhibitors, statins, penicillamine, and TNF inhibitors. A median of 60 (21-288) days elapsed between drug initiation and the onset of the condition.

The review was conducted by researchers from the Stanford University School of Medicine Department of Dermatology. The following study excerpts have been edited for length and clarity.

What was the specific impetus for this systematic review?

Given the increasing frequency of drug-induced DM attributed to oncologic therapy, larger studies have been needed to determine effective treatments to mitigate disease burden and minimize interruptions to therapy.

Although cases of drug-induced DM have previously been reported, according to researchers, there was previously no large-scale review of drug-induced DM culprits and clinical characteristics.

What were the review's top-line results?

Hydroxyurea was the most frequently associated medication (50 [30.3%]), followed by immune checkpoint inhibitors (27 [16.4%]), statins (22 [13.3%]), penicillamine (10 [6.1%]), and TNF inhibitors (10 [6.1%]).

A total of 85 cases (51.6%) of drug-induced DM occurred in patients with cancer; the most common cancer types were chronic myelogenous leukemia, melanoma, breast cancer, and polycythemia vera. Fifteen of 166 patients (9.1%) had prior rheumatic disease: 11 with rheumatoid arthritis, 3 with idiopathic DM, and 2 with psoriasis.

The review also provided insight into diagnosing drug-induced DM.

Drug-induced DM was confirmed by histopathological analysis in 58 of 165 patients (35.2%).

This systematic review showed that patients with cutaneous findings and/or muscle weakness who were taking reported culprits for drug-induced DM could have benefited from early dermatologic evaluation for drug-induced DM.

What can dermatologists take from these findings?

It is essential that drug-induced DM is recognized and diagnosed promptly so dermatologists can guide management and minimize interruption of therapy when possible.

As such, dermatologists need to maintain a low threshold of suspicion for drug-induced DM in patients taking the medications identified through the literature, particularly those with photo-distributed rash and/or muscle weakness.

Finally, these results can also help inform disease-specific guidelines for patients with drug-induced DM.

Key points

• Drug-induced DM is on the rise, driven in part by oncologic drugs. Early detection is key to preventing suspension of important therapies.
• Hydroxyurea was most frequently associated with drug-induced DM, followed by immune checkpoint inhibitors, statins, penicillamine, and TNF inhibitors.
• Dermatologists should monitor closely for drug-induced DM, particularly in patients who have photo-distributed rash and/or muscle weakness.