RT Journal Article
SR Electronic
T1 Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatica: a prospective longitudinal study
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1506
OP 1510
DO 10.1136/annrheumdis-2015-208742
VO 75
IS 8
A1 Valérie Devauchelle-Pensec
A1 Jean Marie Berthelot
A1 Divi Cornec
A1 Yves Renaudineau
A1 Thierry Marhadour
A1 Sandrine Jousse-Joulin
A1 Solène Querellou
A1 Florent Garrigues
A1 Michel De Bandt
A1 Maelenn Gouillou
A1 Alain Saraux
YR 2016
UL http://ard.bmj.com/content/75/8/1506.abstract
AB 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'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 30.4–43.8). 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 (3.2–6.8) and 0.95 (IQR 0.4–2), 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.