COMMENTARY

A Promising Treatment for Polymyalgia Rheumatica

Kevin D. Deane, MD, PhD

Disclosures

November 11, 2016

Viewpoint

This small open-label study joins a number of others demonstrating that anti-IL-6 therapy with tocilizumab can be effective in PMR or giant-cell arteritis (GCA), as well as steroid sparing.[1,2,3] These findings are particularly exciting given the long history of failure of multiple other agents in the management of PMR and GCA, and they may reflect that disease pathogenesis is rooted in IL-6-related pathways.[4]

However, the data in this area are still largely from uncontrolled trials, and therefore we need more robust clinical trials to inform us how best to use IL-6 blockade in the management of PMR and GCA. In particular, while most rheumatologists are in favor of steroid-sparing agents, as discussed by Moiseev and colleagues in a letter to the editor earlier this year,[5] we will need to carefully evaluate the balance between the steroid-sparing effects of IL-6 blockade and its potential complications, especially in PMR where often low-dose steroid therapy is sufficient to control disease. Given that as of October 2016 the US Food and Drug Administration has granted "breakthrough therapy designation" status to tocilizumab for GCA, and a major phase 3 study has recently completed, we should be hearing more soon about this agent in the PMR/GCA spectrum of diseases.

Abstract

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