Steroid-Sparing Effect of Tocilizumab and Methotrexate in Patients with Polymyalgia Rheumatica: A Retrospective...

Area of Science:

• Rheumatology
• Clinical Immunology

Background:

• Polymyalgia rheumatica (PMR) is a common inflammatory condition affecting elderly individuals, causing pain and stiffness.
• Current treatment often relies on corticosteroids, which have significant long-term side effects.
• The steroid-sparing efficacy of newer agents like methotrexate and tocilizumab in PMR requires further clinical investigation.

Purpose of the Study:

• To evaluate the steroid-sparing effect of tocilizumab and methotrexate in patients with polymyalgia rheumatica in a real-world clinical setting.
• To compare the reduction in prednisolone dosage and discontinuation rates among different treatment groups.

Main Methods:

• Retrospective cohort study of 227 consecutive PMR patients (2005-2015).
• Patients were categorized into three groups: prednisolone alone, methotrexate ± prednisolone, and tocilizumab ± prednisolone.
• Comparison of the final prednisolone dose and discontinuation rates across the groups.

Main Results:

• The tocilizumab group achieved significantly lower final prednisolone doses (0 mg/day) compared to the prednisolone (3.0 mg/day) and methotrexate (3.5 mg/day) groups (p < 0.001).
• Higher rates of prednisolone discontinuation were observed in the tocilizumab group (80.0%) versus the methotrexate (28.3%) and prednisolone (18.8%) groups (p < 0.0001).
• No significant differences in baseline characteristics were noted among the treatment groups.

Conclusions:

• Tocilizumab exhibits a notable steroid-sparing effect in the management of polymyalgia rheumatica.
• Tocilizumab represents a promising therapeutic option for PMR, potentially enabling reduced corticosteroid use.
• Further prospective studies are recommended to validate these clinical findings.