@article {Devauchelle-Pensec1506, author = {Val{\'e}rie Devauchelle-Pensec and Jean Marie Berthelot and Divi Cornec and Yves Renaudineau and Thierry Marhadour and Sandrine Jousse-Joulin and Sol{\`e}ne Querellou and Florent Garrigues and Michel De Bandt and Maelenn Gouillou and Alain Saraux}, title = {Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatica: a prospective longitudinal study}, volume = {75}, number = {8}, pages = {1506--1510}, year = {2016}, doi = {10.1136/annrheumdis-2015-208742}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Glucocorticoids are the cornerstone treatment of polymyalgia rheumatica (PMR) but induce adverse events.Objectives To evaluate the efficacy and safety of first-line tocilizumab in PMR.Methods In a prospective open-label study (ClinicalTrials.gov: NCT01713842), 20 glucocorticoid-free patients fulfilling Chuang{\textquoteright}s PMR criteria, with symptom onset within the last 12 months and a PMR activity score (PMR-AS) \>10, each received three tocilizumab infusions at 4-week intervals, without glucocorticoids, followed by oral prednisone from weeks 12 to 24 (0.15 mg/kg if PMR-AS <=10 and 0.30 mg/kg otherwise). The primary end point was the proportion of patients with PMR-AS<=10 at week 12.Results Baseline median PMR-AS was 36.6 (IQR 30.4{\textendash}43.8). At week 12, all patients had PMR-AS<=10 and received the low prednisone dosage. Median PMR-AS at weeks 12 and 24 was 4.5 (3.2{\textendash}6.8) and 0.95 (IQR 0.4{\textendash}2), respectively (p\<0.001 vs baseline for both time points). No patient required rescue treatment. Positron emission tomography-CT showed significant improvements. The most common adverse events were transient neutropenia (n=3) and leucopenia (n=5); in one patient, the second tocilizumab infusion was omitted due to leucopenia.Conclusions Tocilizumab monotherapy is effective in recent-onset PMR. Randomised controlled trials are warranted.Trial registration number NCT01713842.}, issn = {0003-4967}, URL = {https://ard.bmj.com/content/75/8/1506}, eprint = {https://ard.bmj.com/content/75/8/1506.full.pdf}, journal = {Annals of the Rheumatic Diseases} }