Background We have recently reported the effectiveness of tocilizumab (TCZ) against polymyalgia rheumatica (PMR) in a case series.
Objectives Here, we aimed to investigate the efficacy of TCZ on the steroid-sparing effect in the treatment of PMR as compared with methotrexate (MTX).
Methods We retrospectively studied all consecutive patients with PMR, diagnosed according to Bird's criteria and/or the 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) provisional classification criteria, who had been treated at Keio University Hospital or National Tokyo Medical Center for at least 6 months between November 2005 and November 2015. The patients were divided into 3 groups based on the treatment at the last follow-up: prednisolone (PSL) monotherapy (PSL group), MTX+PSL (MTX group) and TCZ+PSL combination therapies (TCZ group). We evaluated the PSL dose in each therapy group at the last follow-up. TCZ was infused at 8 mg/kg every 4 weeks. 3 patients treated with both MTX and TCZ were excluded.
Results Of 220 patients, 173 were in the PSL group, 32 in the MTX group, and 15 in the TCZ group. No difference was found in the proportion of women, mean age and the initial PSL dose among the PSL, MTX, and TCZ group (female, 72.8%, 78.1%, 73.3%; mean age, 73.1, 72.5, 74.1 years; initial PSL dose, 14.2, 16.2, 16.1 mg/day, respectively). The disease duration at the last follow-up in the PSL, MTX, and TCZ groups was 80.5, 60.4, and 43.3 months, respectively. The duration of MTX/TCZ use in combination with PSL was not different between the MTX and TCZ groups (30.2 vs 22.3 months, P=0.56). The PSL dose at the last follow-up in the TCZ group was much lower than the PSL and MTX groups (0.3, 3.2, 4.0 mg/day, P<0.0001). The patients in the TCZ group could discontinued PSL more frequently than the PSL and MTX groups (80.0%, 28.3%, 18.8%, P<0.0001 between the PSL and TCZ groups; P<0.0001 between the MTX and TCZ groups). The reduction in daily PSL dose at 6 months from the initiation of MTX/TCZ was much higher in the TCZ group than in the MTX group (-74.7% vs -29.6%, P<0.0001). Two patients discontinued MTX treatment because of adverse events (pneumonia and nausea) while none discontinued TCZ treatment.
Conclusions TCZ is significantly steroid-sparing compared with MTX in the treatment of PMR. TCZ but not MTX may serve as an effective therapeutic option for patients who require quick reduction or discontinuation of PSL.
Izumi K, Kuda H, Ushikubo M, Kuwana M, Takeuchi T, Oshima H. Tocilizumab is effective against polymyalgia rheumatica: experience in 13 intractable cases. RMD Open. 2015;1(1):e000162.
Disclosure of Interest None declared
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