The Efficacy and Safety of the Anti-IL-6 Receptor Antibody Tocilizumab for Polymyalgia Rheumatica Patients with Resistance or Intolerance to Glucocorticoids and Methotrexate

Manami Hirata¹, Akiko Ueno², kazuyuki fujita², Nobuyuki Shibutou² and Masahiro Yamamura³, ¹Center for Rheumatology, Okayama Saiseikai General Hospital, Okayama, Japan, ²Centor for Rheumatology, Okayama Saiseikai General Hospital, Okayama, Japan, ³Okayama Saiseikai General Hospital, Okayama, Japan

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: glucocorticoids, methotrexate (MTX), polymyalgia rheumatica and tocilizumab

Session Information

Date: Sunday, November 5, 2017

Title: Vasculitis Poster I: Large Vessel Vasculitis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Some patients show inadequate responses to initial glucocorticoids (GC) doses or relapses during GC tapering and develop side effects of GCs. The 2015 EULAR/ACR recommendations for the management of PMR has been proposed, in which early introduction of methotrexate (MTX) in addition to GCs was recommended for such GC-resistance or GC-intolerance. A recent trial of tocilizumab (TCZ) in patients with newly diagnosed PMR, conducted in Europe and the United States, has shown its efficacy and safety. To determine the efficacy and safety of TCZ for patients with resistance or intolerance to GCs and/or MTX.

Methods: Sixty patients had been diagnosed with having PMR since 2011. The patients are all compatible with the 2012 EULAR/ACR provisional classification criteria for PMR, and had been treated first with GC and then, if they were resistant or intolerant to GC, were added MTX, similarly to the 2015 EULAR/ACR recommendations for the management of PMR. In GCs and MTX resistant patients we assessed the efffects of tocilizumab plus GCs and MTX. The disease activity were measured by PMR-AS.

Results: There were 16 patients with GC/MTX resistant or intolerant PMR (26.7%). Of them, 8 patients with PMR agreed to the proposal of TCZ addition, and their therapeutic responses to TCZ and its safety were determined. They were at the age of 69.1 ± 11.3, including two males and six females. Before TCZ addition, the patients were treated with prednisolone (PSL) at 6.9 ± 2.4 mg/day plus MTX at 6.0 ± 4.1 mg/week, and serum CRP were at 1.0 ± 1.1 mg/dL. After 9.3 ± 6.6 months of TCZ treatment, PSL and MTX had been reduced to 0.9 ± 1.2 mg/day and 2.3 ± 3.3 mg/week, respectively, with CRP at 0.02 ± 0 mg/dL. GCs were able to be withdrawn in 5 patients, and MTX were addtionally withdrawn in 2 patients. Two patients reached drug-free remission, as judged from MR-AS (< 1.5). During TCZ therapy, each one patient showed the worsening of depression and occlusion of the central retinal vein.

Conclusion: These results indicate that TCZ may provide a therapeutic option for patients with severe PMR who were resistant or intolerant to GC and additional MTX.

Disclosure: M. Hirata, None; A. Ueno, None; K. fujita, None; N. Shibutou, None; M. Yamamura, None.

To cite this abstract in AMA style:

Hirata M, Ueno A, fujita K, Shibutou N, Yamamura M. The Efficacy and Safety of the Anti-IL-6 Receptor Antibody Tocilizumab for Polymyalgia Rheumatica Patients with Resistance or Intolerance to Glucocorticoids and Methotrexate [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-efficacy-and-safety-of-the-anti-il-6-receptor-antibody-tocilizumab-for-polymyalgia-rheumatica-patients-with-resistance-or-intolerance-to-glucocorticoids-and-methotrexate/. Accessed .

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