Tocilizumab induces remission in polymyalgia rheumatica even without glucocorticoids

Monotherapy with tocilizumab (TCZ) shows good tolerability profile and results in remission in most patients with polymyalgia rheumatica (PMR) despite the absence of glucocorticoids, according to the 2-year results of a single-centre, open‐label pilot study.

A total of 13 patients (average age, 70.1 years; average PMR duration, 4.0 months) received TCZ (8 mg/kg) at fortnightly intervals for the first 2 months, then monthly over the next 10 months. These patients were observed for another year without any treatment.

The primary endpoint of remission occurred in four patients at week 12, yielding a rate of 31 percent. There were four patients who discontinued treatment: two due to adverse events and another two due to lack of effect.

At week 52, the nine remaining patients who completed 1 year of treatment were all in remission. All but one patient completed the follow-up at year 2, of which seven maintained remission.

A systemic inflammatory disease in the elderly of unknown aetiology, PMR is treated with glucocorticoids, although the drug is associated with frequent occurrences of various adverse events, researchers noted.

TCZ, on the other hand, is a major candidate therapeutic strategy for PMR in older patients with comorbidities that inhibit the use of glucocorticoids, they said, adding that this is despite several issues that might limit its use, including the cost and risks of infection and dyslipidaemia.

The researchers underscored a need to conduct further clinical studies to address several outstanding questions about TCZ treatment for PMR, including the frequency of infusions, treatment period and possibility of the use of subcutaneous injections.