Polymyalgia rheumatica (PMR) is the second most common inflammatory rheumatic disease in older people after rheumatoid arthritis. According to the 2015 EULAR-ACR recommendations for the management of PMR, oral glucocorticoids (GC) are the first choice treatment for this condition. It is recommended to choose the minimum effective GC dose within a range of 12.5–25mg prednisone equivalent daily as the initial therapy and to gradually taper the dose, based on regular monitoring of patient disease activity, laboratory markers and adverse events. An early introduction of methotrexate (MTX) in addition to GCs may be considered, particularly in patients at high risk for relapse and/or prolonged therapy as well as in cases with risk factors, co-morbidities, and/or concomitant medications where GC related adverse events are more likely to occur. For other conventional disease modifying anti-rheumatic drugs (DMARDs), a specific recommendation was not possible due to the absence of good evidence. Among biological agents, infliximab and etanercept failed its primary endpoint in randomized controlled trials, and consequently, a strong recommendation against the use of TNF-a blocking agents was made.
Since the publication of 2015 EULAR-ACR recommendations, observational studies and small, randomized trials reported promising results about the effective use of interleukin (IL)-6 blocking agents in PMR. If these preliminary data are confirmed by larger randomized controlled trials, IL-6 blockade might become an important therapeutic option for PMR patients in future.
In this session, we will discuss current evidence on the role of steroid sparing agents in the treatment of PMR including the promising new results from studies on IL-6 blockade.
Disclosure of Interest C. Dejaco Grant/research support from: Pfizer, MSD, Consultant for: MSD, Pfizer, UCB, AbbVie, Roche, GSK, Novartis, Lilly, BMS, Celgene, Speakers bureau: MSD, Pfizer, UCB, AbbVie, Roche, GSK, Novartis, Lilly, BMS, Celgene, Merck, Signatis Pharma