Limits...
Tocilizumab is effective against polymyalgia rheumatica: experience in 13 intractable cases.

Izumi K, Kuda H, Ushikubo M, Kuwana M, Takeuchi T, Oshima H - RMD Open (2015)

Bottom Line: Administration of tocilizumab significantly improved inflammation and PMR symptoms such as morning stiffness, as well as the Patient-Pain and Patient-Global Assessment visual analogue scales (p<0.05).Severe adverse events were not observed during the mean tocilizumab treatment period of 43.4 weeks.Our findings suggest that tocilizumab is effective and safe for PMR treatment.

View Article: PubMed Central - PubMed

Affiliation: Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan ; Department of Connective Tissue Diseases , National Tokyo Medical Center , Tokyo , Japan.

ABSTRACT
Polymyalgia rheumatica (PMR) affects older people, and although glucocorticoids are effective in treating PMR, they frequently result in side effects. Therefore, we conducted a retrospective study to assess the effectiveness and safety of tocilizumab as an alternative to glucocorticoids. We included 13 consecutive patients with PMR (11 women and 2 men; median age, 74 years) diagnosed according to Bird's criteria and the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria. All patients received tocilizumab infusion (8 mg/kg every 4 weeks) at our institutions, between 2008 and 2014, because of PMR relapses (n=12) or insufficient response to initial prednisolone treatment (n=1), without increasing prednisolone dosage. Seven patients were on methotrexate, and all had one or more glucocorticoid-related comorbidities. Administration of tocilizumab significantly improved inflammation and PMR symptoms such as morning stiffness, as well as the Patient-Pain and Patient-Global Assessment visual analogue scales (p<0.05). Proximal muscle pain disappeared within 8 weeks, on average, and the Health Assessment Questionnaire-Disability Index scores (p=0.098) and concomitant prednisolone doses (p<0.05) decreased at 12 weeks. Severe adverse events were not observed during the mean tocilizumab treatment period of 43.4 weeks. Our findings suggest that tocilizumab is effective and safe for PMR treatment.

No MeSH data available.


Related in: MedlinePlus

Changes in evaluation indicators from baseline to 12 weeks per visit. (A) Duration of morning stiffness (MS), (B) Patient-Pain, (C) Patient-Global Assessment (GA), (D) C-reactive protein (CRP), (E) erythrocyte sedimentation rate (ESR) and (F) prednisolone (PSL) doses (VAS, visual analogue scale). Asterisks indicate significant differences as compared with baseline analysed by Wilcoxon signed-rank test. *p<0.05, **p<0.01, ***p<0.001 and ****p<0.0001.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4663453&req=5

RMDOPEN2015000162F1: Changes in evaluation indicators from baseline to 12 weeks per visit. (A) Duration of morning stiffness (MS), (B) Patient-Pain, (C) Patient-Global Assessment (GA), (D) C-reactive protein (CRP), (E) erythrocyte sedimentation rate (ESR) and (F) prednisolone (PSL) doses (VAS, visual analogue scale). Asterisks indicate significant differences as compared with baseline analysed by Wilcoxon signed-rank test. *p<0.05, **p<0.01, ***p<0.001 and ****p<0.0001.

Mentions: Tocilizumab significantly improved PMR symptoms such as morning stiffness (MS), Patient-Pain and Patient-GA (figure 1A–C). Proximal muscle pain disappeared in 8 weeks (range 4–24 weeks) on average. Median C-reactive protein (CRP) level and erythrocyte sedimentation rate significantly decreased from 2.30 mg/dL (range 0.30–14.72 mg/dL) at baseline to 0.24 mg/dL (range 0.01–2.80 mg/dL) at 4 weeks and from 46 mm/h (range 19–99 mm/h) to 6 mm/h (range 2–46 mm/h), respectively (figure 1D, E). Health Assessment Questionnaire-Disability Index scores decreased from 0.375 (range 0–2.75) at baseline to 0 (range 0–1.75) at 12 weeks (p=0.098). Overall, concomitant prednisolone doses significantly decreased from 6 mg/day (range 0–14 mg/day) at baseline to 1 mg/day (range 0–9 mg/day) at 12 weeks (figure 1F). Prednisolone doses were reduced by 1 mg every month in 12 patients and by 0.5 mg every month in 1 patient. Of 12 patients who used prednisolone at baseline, 7 had discontinued prednisolone by the last follow-up. The mean tapering rate of prednisolone over the follow-up period was 1.3 mg/day (range 0–2.5 mg/day) per 4 weeks. VAS of Physician-GA significantly decreased from 36.5 (range 2–93) at baseline to 6.5 (range 0–18) at 4 weeks (p=0.004).


Tocilizumab is effective against polymyalgia rheumatica: experience in 13 intractable cases.

Izumi K, Kuda H, Ushikubo M, Kuwana M, Takeuchi T, Oshima H - RMD Open (2015)

Changes in evaluation indicators from baseline to 12 weeks per visit. (A) Duration of morning stiffness (MS), (B) Patient-Pain, (C) Patient-Global Assessment (GA), (D) C-reactive protein (CRP), (E) erythrocyte sedimentation rate (ESR) and (F) prednisolone (PSL) doses (VAS, visual analogue scale). Asterisks indicate significant differences as compared with baseline analysed by Wilcoxon signed-rank test. *p<0.05, **p<0.01, ***p<0.001 and ****p<0.0001.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663453&req=5

RMDOPEN2015000162F1: Changes in evaluation indicators from baseline to 12 weeks per visit. (A) Duration of morning stiffness (MS), (B) Patient-Pain, (C) Patient-Global Assessment (GA), (D) C-reactive protein (CRP), (E) erythrocyte sedimentation rate (ESR) and (F) prednisolone (PSL) doses (VAS, visual analogue scale). Asterisks indicate significant differences as compared with baseline analysed by Wilcoxon signed-rank test. *p<0.05, **p<0.01, ***p<0.001 and ****p<0.0001.
Mentions: Tocilizumab significantly improved PMR symptoms such as morning stiffness (MS), Patient-Pain and Patient-GA (figure 1A–C). Proximal muscle pain disappeared in 8 weeks (range 4–24 weeks) on average. Median C-reactive protein (CRP) level and erythrocyte sedimentation rate significantly decreased from 2.30 mg/dL (range 0.30–14.72 mg/dL) at baseline to 0.24 mg/dL (range 0.01–2.80 mg/dL) at 4 weeks and from 46 mm/h (range 19–99 mm/h) to 6 mm/h (range 2–46 mm/h), respectively (figure 1D, E). Health Assessment Questionnaire-Disability Index scores decreased from 0.375 (range 0–2.75) at baseline to 0 (range 0–1.75) at 12 weeks (p=0.098). Overall, concomitant prednisolone doses significantly decreased from 6 mg/day (range 0–14 mg/day) at baseline to 1 mg/day (range 0–9 mg/day) at 12 weeks (figure 1F). Prednisolone doses were reduced by 1 mg every month in 12 patients and by 0.5 mg every month in 1 patient. Of 12 patients who used prednisolone at baseline, 7 had discontinued prednisolone by the last follow-up. The mean tapering rate of prednisolone over the follow-up period was 1.3 mg/day (range 0–2.5 mg/day) per 4 weeks. VAS of Physician-GA significantly decreased from 36.5 (range 2–93) at baseline to 6.5 (range 0–18) at 4 weeks (p=0.004).

Bottom Line: Administration of tocilizumab significantly improved inflammation and PMR symptoms such as morning stiffness, as well as the Patient-Pain and Patient-Global Assessment visual analogue scales (p<0.05).Severe adverse events were not observed during the mean tocilizumab treatment period of 43.4 weeks.Our findings suggest that tocilizumab is effective and safe for PMR treatment.

View Article: PubMed Central - PubMed

Affiliation: Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan ; Department of Connective Tissue Diseases , National Tokyo Medical Center , Tokyo , Japan.

ABSTRACT
Polymyalgia rheumatica (PMR) affects older people, and although glucocorticoids are effective in treating PMR, they frequently result in side effects. Therefore, we conducted a retrospective study to assess the effectiveness and safety of tocilizumab as an alternative to glucocorticoids. We included 13 consecutive patients with PMR (11 women and 2 men; median age, 74 years) diagnosed according to Bird's criteria and the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria. All patients received tocilizumab infusion (8 mg/kg every 4 weeks) at our institutions, between 2008 and 2014, because of PMR relapses (n=12) or insufficient response to initial prednisolone treatment (n=1), without increasing prednisolone dosage. Seven patients were on methotrexate, and all had one or more glucocorticoid-related comorbidities. Administration of tocilizumab significantly improved inflammation and PMR symptoms such as morning stiffness, as well as the Patient-Pain and Patient-Global Assessment visual analogue scales (p<0.05). Proximal muscle pain disappeared within 8 weeks, on average, and the Health Assessment Questionnaire-Disability Index scores (p=0.098) and concomitant prednisolone doses (p<0.05) decreased at 12 weeks. Severe adverse events were not observed during the mean tocilizumab treatment period of 43.4 weeks. Our findings suggest that tocilizumab is effective and safe for PMR treatment.

No MeSH data available.


Related in: MedlinePlus