title: Tocilizumab is effective against polymyalgia rheumatica: experience in 13 intractable cases.
abstract: Polymyalgia rheumatica (PMR) affects older people, and although glucocorticoids are effective in treating PMR, they frequently result in side effects. Therefore, we conducted a retrospective study to assess the effectiveness and safety of tocilizumab as an alternative to glucocorticoids. We included 13 consecutive patients with PMR (11 women and 2 men; median age, 74 years) diagnosed according to Bird's criteria and the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria. All patients received tocilizumab infusion (8 mg/kg every 4 weeks) at our institutions, between 2008 and 2014, because of PMR relapses (n=12) or insufficient response to initial prednisolone treatment (n=1), without increasing prednisolone dosage. Seven patients were on methotrexate, and all had one or more glucocorticoid-related comorbidities. Administration of tocilizumab significantly improved inflammation and PMR symptoms such as morning stiffness, as well as the Patient-Pain and Patient-Global Assessment visual analogue scales (p<0.05). Proximal muscle pain disappeared within 8 weeks, on average, and the Health Assessment Questionnaire-Disability Index scores (p=0.098) and concomitant prednisolone doses (p<0.05) decreased at 12 weeks. Severe adverse events were not observed during the mean tocilizumab treatment period of 43.4 weeks. Our findings suggest that tocilizumab is effective and safe for PMR treatment.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan ; Department of Connective Tissue Diseases , National Tokyo Medical Center , Tokyo , Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Izumi
authors.affiliation: Department of Connective Tissue Diseases , National Tokyo Medical Center , Tokyo , Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Kuda
authors.affiliation: Department of Connective Tissue Diseases , National Tokyo Medical Center , Tokyo , Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Ushikubo
authors.affiliation: Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan ; Department of Allergy and Rheumatology , Nippon Medical School , Tokyo , Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kuwana
authors.affiliation: Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
authors.affiliation: Department of Connective Tissue Diseases , National Tokyo Medical Center , Tokyo , Japan.
authors.forename: Hisaji
authors.initials: H
authors.lastname: Oshima
keywords: Corticosteroids; Cytokines; DMARDs (biologic); Polymyalgia Rheumatica; Treatment