Polymyalgia rheumatica: new treatment option may be on the horizon
A drug already approved to treat rheumatoid arthritis, tocilizumab, could become a new therapy for people with polymyalgia rheumatica, in the light of a study presented at the annual meeting of the American College of Rheumatology.
Polymyalgia rheumatic is an inflammatory condition that causes many painful muscles, most frequently those of the thigh and shoulder, and can cause people to feel as though they have flu, with mild fever, fatigue and malaise. It usually affects those over 60 years (more often women than men) but can start at any age from 50 years.
Steroids are the main current treatment option, but these can have side effects such as skin fragility, diabetes, osteoporosis, cognitive disturbances and muscle weakness.
Tocilizumab is designed to block a protein that is involved in various inflammatory disorders. Some studies have shown that people with polymyalgia rheumatica have high levels of this protein, so a research group decided to test if tocilizumab could help.
They enrolled 10 people with newly diagnosed polymyalgia rheumatica who had received less than one month of treatment with corticosteroids. The volunteers received tocilizumab once a month by intravenous infusion as well as corticosteroids, and were tapered off the steroids within four months, much more quickly than is done in routine clinical practice.
One volunteer withdrew after two months due to an infusion reaction. All of the remaining nine people achieved relapse-free remission and were no longer taking corticosteroids at six months. After one year, all remained in remission without relapse. Tocilizumab was well tolerated.
Another group of 10 people diagnosed with polymyalgia rheumatica were treated with only corticosteroids. In this group, no-one was in remission without taking corticosteroids at six months, and 60% had relapsed at 12 months.
The next step is a larger trial to confirm that the drug works for polymyalgia rheumatica. But even if it has positive results, the drug’s price may be a barrier to it being incorporated in clinical practice.
“It is expensive, like all of our biologics,” explains lead author, Dr Robert Spiera. “If cost were not an issue though, I think it could potentially be a favored way of approaching this disease if the safety and efficacy suggested in our open label trial is confirmed in a larger controlled study.
“Occasionally in practice, we see people who are having a very hard time getting off steroids, because they have refractory disease, or we see people in whom you know that steroids are going to be particularly problematic. Examples include patients with diabetes, osteoporosis with multiple fractures in the past, or they are very frail. This proof of concept trial suggests that this could be a strategy in those selected patients to minimize their steroid exposure.”
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Image credit: H Powers
