Effective control of polymyalgia rheumatica with tocilizumab.

Abstract

Despite their disadvantages, glucocorticoids (GCs) remain a mainstay of therapy for polymyalgia rheumatica (PMR). Second-line antirheumatic and immune-modulatory drugs are not infrequently required because of disease relapses during GC tapering and GC adverse effects. Therapy with methotrexate or with an anti-tumor necrosis factor drug showed modest efficacy in this situation. Tocilizumab (TCZ) is an anti-interleukin 6 receptor antibody that is being recently studied in the treatment of PMR patients who are intolerant or refractory to GCs, especially after failure of a second-line agent. We report a case of PMR in which GCs were stopped because of adverse effects despite good response. The condition responded to neither methotrexate nor etanercept. Treatment with TCZ has led to significant improvement of the patient's clinical and biochemical PMR activity parameters, and she was kept in a solid remission for 1 year without any TCZ-related adverse effects. Tocilizumab is a promising drug in the management of PMR. Further studies are required to clearly define the indications and duration of TCZ therapy in the management of PMR.

• Authors: Abdulrahman Al Rashidi, Mohamed Osama Hegazi, Shaimaa A Mohammad, Alex Varghese
• Journal: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases (J Clin Rheumatol) Vol. 19 Issue 7 Pg. 400-1 (Oct 2013) ISSN: 1536-7355 [Electronic] United States
• PMID: 24048113 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Receptors, Interleukin-6
• tocilizumab

Topics

• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Disease Management
• Female
• Humans
• Middle Aged
• Polymyalgia Rheumatica (drug therapy)
• Receptors, Interleukin-6 (antagonists & inhibitors)
• Treatment Outcome