Background A recent trial of tocilizumab (TCZ) in patients with newly diagnosed polymyalgia rheumatica (PMR), conducted in Europe and the United States, has shown its efficacy and safety.
Objectives We examined the efficacy and safety of TCZ for patients with PMR who had been primarily resistant or intolerant to glucocorticoids (GC) and additional methotrexate (MTX).
Methods Sixty patients had been diagnosed with having PMR since 2011. The patients are all compatible with the 2012 EULAR/ACR provisional classification criteria for PMR, and had been treated first with GC and then, if they were resistant or intolerant to GC, were added MTX, similarly to the 2015 EULAR/ACR recommendations for the management of PMR. The disease activity were measured by PMR-AS.
Results There were 17 patients with GC/MTX resistant or intolerant PMR (28%). Of them, 9 patients with PMR agreed to the proposal of TCZ addition, and their therapeutic responses to TCZ and its safety were determined. They were at the age of 68.2±10.6, including three males and six females. Before TCZ addition, the patients were treated with prednisolone (PSL) at 7.6±3.0 mg/day plus MTX at 7.1±5.1 mg/week, and serum CRP were at 1.0±1.0 mg/dL. After 8.4±5.7 months of TCZ treatment, PSL and MTX had been reduced to 1.1±1.3 mg/day and 3.3±4.5 mg/week, respectively, with CRP at 0.02±0 mg/dL. GC were able to be withdrawn in 5 patients, and MTX were further withdrawn in 4 patients. Two patients reached drug-free remission (PMR-AS=0.02). During TCZ therapy, each one patient showed the worsening of depression and occlusion of the central retinal vein.
Conclusions These results indicate that TCZ may provide a therapeutic option for patients with severe PMR who were resistant or intolerant to GC and additional MTX.
Disclosure of Interest None declared