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Tocilizumab controls bone turnover in early polymyalgia rheumatica.

Guillermo Carvajal Alegria1, Florent Garrigues2, Eleonore Bettacchioli3

  • 1Rheumatology department, CHRU Cavale Blanche, Brest, France; Lymphocytes B et autoimmunité, UMR1227, INSERM, Université de Bretagne Occidentale, Brest, France.

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Summary

Tocilizumab treatment in polymyalgia rheumatica (PMR) patients improved bone formation markers (PINP) and reduced bone resorption markers (CTX-I). This suggests tocilizumab helps control bone turnover, partly by inhibiting the IL-6 pathway.

Keywords:
CTX-IIL-6PINPPolymyalgia rheumaticaScanographic bone attenuation coefficientTocilizumab

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Area of Science:

  • Rheumatology
  • Bone Metabolism
  • Immunology

Background:

  • Polymyalgia rheumatica (PMR) is associated with altered bone homeostasis, including reduced bone mineral density.
  • Biomarkers of bone formation (PINP) and resorption (CTX-I) are crucial for assessing bone turnover in inflammatory conditions.

Purpose of the Study:

  • To investigate the effects of tocilizumab on bone turnover markers (PINP and CTX-I) in patients with polymyalgia rheumatica (PMR).
  • To evaluate the correlation between bone formation and resorption markers before and after treatment.
  • To explore the relationship between interleukin-6 (IL-6) levels and changes in bone metabolism.

Main Methods:

  • Prospective open-label TENOR study involving 20 PMR patients treated with tocilizumab and corticosteroids.
  • Measurement of PINP and CTX-I at baseline (W0), after tocilizumab (W12), and at study end (W24).
  • Comparison with healthy controls, alongside assessment of disease activity, bone mineral density, and IL-6 levels.

Main Results:

  • PMR patients exhibited lower bone density and higher CTX-I at baseline compared to controls.
  • Tocilizumab increased PINP levels (W12), while CTX-I levels decreased after steroid initiation (W24).
  • Treatment corrected the altered PINP-CTX-I correlation observed at baseline, with changes linked to IL-6 reduction.

Conclusions:

  • Tocilizumab and subsequent corticosteroid treatment in PMR patients positively influence bone turnover.
  • Inhibition of the IL-6 axis appears to play a role in controlling bone metabolism during treatment.
  • The findings highlight tocilizumab's potential in managing bone health in PMR patients.