Treatment of refractory polymyalgia rheumatica with infliximab: a pilot study.
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.


CONCLUSIONS
Our encouraging results suggest that a controlled study may assess the efficacy of infliximab as CS-sparing drug in PMR.
Salvarani
Carlo
C
Unità Reumatologica, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. salvarani.carlo@asmn.re.it
Cantini
Fabrizio
F
Niccoli
Laura
L
Catanoso
Maria Grazia
MG
Macchioni
Pierluigi
P
Pulsatelli
Lia
L
Padula
Angela
A
Olivieri
Ignazio
I
Boiardi
Luigi
L
D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D010865:Pilot Projects; D011111:Polymyalgia Rheumatica / Q000097:blood / Q000188:drug therapy*; D012008:Recurrence; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D015850:Interleukin-6; D002097:C-Reactive Protein; D000069285:Infliximab