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Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatica: a prospective longitudinal study
Open accessAbstract
BACKGROUND: Glucocorticoids are the cornerstone treatment of polymyalgia rheumatica (PMR) but induce adverse events. OBJECTIVES: To evaluate the efficacy and safety of first-line tocilizumab in PMR. METHODS: In a prospective open-label study (ClinicalTrials.gov: NCT01713842), 20 glucocorticoid-free patients fulfilling Chuang's PMR criteria, with symptom onset within the last 12 months and a PMR activity score (PMR-AS) >10, each received three tocilizumab infusions at 4-week intervals, without glucocorticoids, followed by oral prednisone from weeks 12 to 24 (0.15 mg/kg if PMR-AS ≤10 and 0.30 mg/kg otherwise). The primary end point was the proportion of patients with PMR-AS≤10 at week 12. RESULTS: Baseline median PMR-AS was 36.6 (IQR 30.4-43.8). At week 12, all patients had PMR-AS≤10 and received the low prednisone dosage. Median PMR-AS at weeks 12 and 24 was 4.5 (3.2-6.8) and 0.95 (IQR 0.4-2), respectively (p<0.001 vs baseline for both time points). No patient required rescue treatment. Positron emission tomography-CT showed significant improvements. The most common adverse events were transient neutropenia (n=3) and leucopenia (n=5); in one patient, the second tocilizumab infusion was omitted due to leucopenia. CONCLUSIONS: Tocilizumab monotherapy is effective in recent-onset PMR. Randomised controlled trials are warranted. TRIAL REGISTRATION NUMBER: NCT01713842.
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Metadata
- Authors
- Devauchelle-Pensec, V., Berthelot, J. M., Cornec, D., Renaudineau, Y., Marhadour, T., Jousse-Joulin, S., Querellou, S., Garrigues, F., De Bandt, M., Gouillou, M., & Saraux, A.
- Affiliations
- Centre Hospitalier Universitaire de Nantes (FR)
- Université de Bretagne Occidentale (FR)
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2016-08
- Volume
- 75
- Issue
- 8
- Pages
- 1506-1510
- ISSN
- 0003-4967 (ISSN-L)
- PMC
- PMC4975852
- OpenAlex
- W2290444582
- Cited by
- 171
- References
- 22
- Citations by year
- 2026: 15 · 2025: 10 · 2024: 18 · 2023: 19 · 2022: 19 · 2021: 17 · 2020: 19 · 2019: 11 · 2018: 18 · 2017: 16 · 2016: 8
- FWCI
- 15.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Annals of the Rheumatic Diseases (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Chugai Pharmaceutical
- Topics
- Health Sciences › Medicine › Rheumatology › Vasculitis and related conditions
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Rheumatology › Otitis Media and Relapsing Polychondritis
- Keywords
- tocilizumab, polymyalgia rheumatica, steroid-sparing therapy, prednisone, IL-6 inhibition, neutropenia, leukopenia, treatment efficacy and safety
- MeSH terms
- Positron Emission Tomography Computed Tomography, Aged, Drug Administration Schedule, Drug Therapy, Combination, Female, Glucocorticoids, Humans, Infusions, Intravenous, Longitudinal Studies, Male, Middle Aged, Polymyalgia Rheumatica, Prednisone, Prospective Studies, Severity of Illness Index, Treatment Outcome, Antirheumatic Agents, Antibodies, Monoclonal, Humanized
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