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Polymyalgia rheumatica (PMR) is among the commonest inflammatory rheumatic diseases for which the cornerstone of treatment is long-term glucocorticoids.1 Adverse effects of glucocorticoids in elderly and often comorbid individuals can lead to significant additional morbidity. Steroid-sparing treatment options are limited and remain a major unmet need. Interleukin 6 (IL-6) signalling is thought to play a key role in PMR pathophysiology, and open-label studies of IL-6 receptor inhibition (IL-6Ri) have shown promising efficacy.2 Open-label studies are susceptible to bias, while effective blinding may be challenging since IL-6Ri reduces C-reactive protein (CRP), which can unblind participants. Natural variation in the gene that encodes a protein drug target can offer insight into the clinical effects of perturbing that target pharmacologically.3 We leveraged large population-level data to examine the effect of genetically proxied IL-6Ri on risk of PMR.
To proxy IL-6Ri, we used seven previously identified variants (online supplemental table S1) within or near the IL6R gene (±300 kilobases), which encode the receptor of IL-6; these variants were uncorrelated (r2 <0.1) and associated with circulating CRP levels at genome-wide significance (p<5×10−8) from a genome-wide association study of 204 402 European individuals.4 These instruments were validated through associations …
Handling editor Josef S Smolen
Twitter @stezhao, @dpsg108
Contributors Both authors contributed to all stages of this research.
Funding SSZ is supported by a National Institute for Health Research Clinical Lectureship and works in centres supported by Versus Arthritis (grant numbers 21755, 21173, 21754 and 21755). DG is supported by the British Heart Foundation Research Centre of Excellence (RE/18/4/34215) at Imperial College London. This research was funded by UK Research and Innovation Medical Research Council (MC_UU_00002/7).
Competing interests DG is employed part-time by Novo Nordisk. All authors declare no conflicts of interest that could bias this work.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability UK Biobank data are available to all bona fide researchers for use in health-related research that is in the public interest. The application procedure is described at www.ukbiobank.ac.uk.
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