Rapid and Sustained Response to Tocilizumab in Patients with Polymyalgia Rheumatica Resistant or Intolerant to Glucocorticoids: A Multicenter Open-label Study

Toussirot, Éric; Martin, Antoine; Soubrier, Martin; Redeker, S; Régent, Alexis

doi:10.3899/jrheum.150599

Cited by 22 publications

(11 citation statements)

References 12 publications

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“…We reported the efficacy of a monthly 8 mg/kg infusion of TCZ in a series of seven patients with isolated PMR. Interestingly, we observed that TCZ may be interrupted after remission achievement in patients who received TCZ 1–4 months after disease onset without subsequent relapse 27. Similar efficacy was reported in a series of 13 patients from Japan 26.…”

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confidence: 86%

Interleukin-6: a promising target for the treatment of polymyalgia rheumatica or giant cell arteritis?

et al. 2016

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confidence: 86%

Interleukin-6: a promising target for the treatment of polymyalgia rheumatica or giant cell arteritis?

et al. 2016

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“…The role of anti-IL-6 treatment for PMR has been evaluated in several small, open-label studies with a duration of 24 to 52 weeks 25,26,[127][128][129] . In aggregate, these studies with a total of 53 patients suggest that anti-IL-6 therapy might be associated with lower glucocorticoid doses and lower rates of relapse than glucocorticoids alone, although symptom relief seemed to occur sooner in glucocorticoid-treated patients.…”

Section: Adjunctive Therapiesmentioning

confidence: 99%

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

et al. 2020

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Giant cell arteritis (GCA) is the most common type of primary vasculitis in Western countries 1,2. Polymyalgia rheumatica (PMR) is the second most common inflammatory rheumatic disease of the elderly after rheumatoid arthritis (RA) 3. The two diseases are interrelated: 40-60% of patients with GCA have symptoms of PMR 3 , and histological features consistent with GCA have been found in 16-21% of temporal artery biopsy samples from patients with PMR 3. Most of these patients with PMR, however, presented with additional features of GCA, whereas the prevalence of positive histology in unselected patients with PMR is unknown. Both GCA and PMR are heterogeneous diseases. Although systemic manifestations (such as fever, malaise and weight loss) are common in both diseases, they are not present in all patients 4-6. Up to 1 in 5 patients with GCA with ocular involvement can present without systemic manifestations of the disease 7. GCA is the most common form of large-vessel vasculitis (LVV) and has a broad spectrum of disease manifestations, which are frequently overlapping. In the majority of cases, cranial and extracranial large arteries are involved to varying degrees, leading to different clinical phenotypes 8,9. Isolated cranial or extracranial GCA, which are at either end of this continuum, are relatively uncommon 10. Predominant cranial GCA is characterized by headache, jaw claudication and visual manifestations (representing the prototypical clinical picture of temporal arteritis). By contrast, predominant large-vessel GCA is characterized by more pronounced systemic manifestations, PMR, vascular bruits, limb claudication and imaging signs of inflammation in the aorta and its major branches 10. In some of these patients, vascular stenoses or aneurysms in association with other GCA features are the presenting clinical manifestations 9,11. PMR is characterized by pain and stiffness in the shoulder and pelvic girdles, which can have an abrupt or a subtle onset 3. Up to 20% of patients with PMR can present with a normal erythrocyte sedimentation rate (ESR) 12 , although the presence of both normal ESR and C-reactive protein (CRP) levels is rare 13-15. Glucocorticoids are the cornerstone of treatment for GCA and PMR. They are effective, but glucocorticoidrelated adverse effects occur in up to 85% of patients with GCA and 65% of patients with PMR, respectively 16-22. The IL-6 receptor inhibitor tocilizumab has become available as a glucocorticoid-sparing strategy in patients with GCA 23,24 , an approach that is also being evaluated for PMR 25,26. Management of both GCA and PMR is hampered by the lack of universally accepted definitions of remission and other disease states (such as low disease activity or vessel damage without active disease). Many questions about monitoring and long-term management are still unanswered (Box 1).

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“…However, the effect of MTX is modest and RCTs of other synthetic DMARDs such as leflunomide are urgently needed. The IL-6 blocking biologic agent, tocilizumab, has shown promising results in GC resistant or intolerant PMR patients and as monotherapy in new onset PMR (18,19). However, development of new treatment regimens in PMR has been hampered by the lack of reliable classification criteria and evidence-based outcome measures.…”

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confidence: 99%

Perspectives and unmet needs in polymyalgia rheumatica. Providing the fundamental framework for the development of new treatment regimes in polymyalgia rheumatica

Nielsen

Dasgupta

2018

Reumatismo

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SUMMARYPolymyalgia rheumatica is effectively treated with glucocorticoids. However, glucocorticoid treatment can cause numerous and potentially serious side effects. Therefore, lowest effective dose and shortest duration to control disease is aimed for and glucocorticoid-sparing treatments are needed. Nevertheless, development of treatment regimens in PMR has been hampered by the lack of reliable classification criteria and evidence-based outcome measures. In this editorial, we discuss the need for valid classification criteria in PMR, the strengths and limitations of the ACR/EULAR 2012 provisional classification criteria for PMR and the need of validation and possible refining of the criteria.

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Rapid and Sustained Response to Tocilizumab in Patients with Polymyalgia Rheumatica Resistant or Intolerant to Glucocorticoids: A Multicenter Open-label Study

Cited by 22 publications

References 12 publications

Interleukin-6: a promising target for the treatment of polymyalgia rheumatica or giant cell arteritis?

Interleukin-6: a promising target for the treatment of polymyalgia rheumatica or giant cell arteritis?

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

Perspectives and unmet needs in polymyalgia rheumatica. Providing the fundamental framework for the development of new treatment regimes in polymyalgia rheumatica

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