Tocilizumab Promising for the Treatment of Polymyalgia Rheumatica

The mean time to first relapse in days (± standard deviation [SD]) for patients who received tocilizumab was 130±13 days compared with patients who received placebo, 82 ± 11 days (P=0.007). At week 16, the median cumulative prednisone dose (interquartile range) was 727 mg (range: 721–842 mg) for patients treated with tocilizumab and 935 mg (861­–1244 mg) for patients who received placebo (P=0.003). At week 24, the glucocorticoid-free remission rates were similar to those at week 16: 57.9% for patients treated with tocilizumab compared with 17.6% of patients on placebo.

Statistical significance was reached for many secondary outcomes, including cumulative prednisone dose at week 24. The cumulative prednisone dose was 781 mg (range: 721–972 mg) for patients treated with tocilizumab and 1,290 mg (1,106–1,809 mg) for patients who received placebo (P=0.001).

Five patients in the placebo group had a serious adverse event, and one serious adverse event occurred in a patient who received tocilizumab. The specifics of these adverse events were not reported.

This study showed that tocilizumab was superior to placebo for sustained glucocorticoid-free remission, time to relapse and cumulative glucocorticoid dose. These results show that tocilizumab may be a viable agent for these patients, improving efficacy and safety in managing PMR.

References

1. Bonelli M, Radner H, Smolen J, et al. Tocilizumab in patients with new onset polymyalgia rheumatica (PMR-SPARE)—A phase 2/3 randomized controlled trial [abstract: 0507]. Arthritis Rheumatol. 2021 Oct;73(suppl 10).
2. Polymyalgia rheumatica. Mayo Clinic. 2021
3. Diseases and conditions: Polymyalgia rheumatica. American College of Rheumatology. 2019 Mar.
4. Aletaha D. A study to evaluate the efficacy of tocilizumab as a remission-induction and glucocorticoid-sparing regimen in subjects with new-onset polymyalgia rheumatica (PMR-SPARE). ClinicalTrials.gov. 2021 Jan 22.