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Treatment of refractory polymyalgia rheumatica with infliximab: a pilot study
Carlo Salvarani1, Fabrizio Cantini, Laura Niccoli
1Unità Reumatologica, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. salvarani.carlo@asmn.re.it
Objective:
To investigate whether infliximab has a steroid-sparing effect in the treatment of patients with polymyalgia rheumatica (PMR) who are resistant to corticosteroid (CS) therapy and have had CS-related side effects.
Methods:
In a pilot study, infliximab 3 mg/kg was administered at weeks 0, 2, and 6 in 4 patients with relapsing PMR who were not able to reduce their prednisone dose below 7.5-12.5 mg/day and who had experienced multiple vertebral fractures. The patients were regularly monitored for clinical signs/symptoms and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) during the one-year followup period.
Results:
Two patients had a complete response to infliximab with clinical remission 2 weeks after the first infusion. At this time ESR and IL-6 values were normal and the patients were able to suspend prednisone. Normal ESR, CRP, and IL-6 levels persisted after the suspension of infliximab and prednisone during the followup period, paralleling the clinical remission. The third patient had a complete and persistent clinical remission 2 weeks after the first infusion, although IL-6 levels remained elevated during the followup period despite the normalization of ESR values. These 3 patients were symptom-free with normal ESR and CRP at the end of 1-year of followup. The fourth patient had continuous clinical activity associated with persistently elevated acute phase reactants, although IL-6 levels measured during followup were lower compared to baseline values and the patient was able to reduce prednisone dosage to 5 mg/day.
Conclusion:
Our encouraging results suggest that a controlled study may assess the efficacy of infliximab as CS-sparing drug in PMR.
Insights
Infliximab shows promise as a steroid-sparing treatment for polymyalgia rheumatica (PMR) patients resistant to corticosteroids. This pilot study found infliximab induced remission and allowed prednisone reduction in most patients with PMR.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Polymyalgia rheumatica (PMR) often requires long-term corticosteroid (CS) therapy.
- Corticosteroid resistance and side effects, such as vertebral fractures, necessitate alternative treatments.
- Investigating novel therapeutic agents for PMR management is crucial.
Observation:
- A pilot study involved four PMR patients resistant to CS therapy.
- Patients received infliximab (3 mg/kg) at weeks 0, 2, and 6.
- Monitoring included clinical assessment and inflammatory markers (ESR, CRP, IL-6) over one year.
Findings:
- Three of four patients achieved complete clinical remission and normalized inflammatory markers within two weeks of the first infliximab infusion.
- Two patients successfully discontinued prednisone.
- One patient experienced partial response with reduced prednisone dosage, while another showed persistent disease activity.
Implications:
- Infliximab demonstrates potential as a steroid-sparing agent in difficult-to-treat PMR.
- These findings support further investigation in controlled clinical trials.
- Targeting inflammatory pathways with biologics like infliximab may offer new therapeutic avenues for PMR.