What agent do you try next in patients with myositis-related interstitial lung disease who are refractory to mycophenolate mofetil and azathioprine?

In those refractory to MMF or AZA, tacrolimus would be the next good option. There is data to support the use of tacrolimus in those who are more refractory, especially those who are MDA5 or have an antisynthetase syndrome.