Biological therapy in polymyalgia rheumatica

ABSTRACT

Introduction

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease of the elderly, treated mainly with systemic corticosteroids. The frequency of side effects of steroids is high in this aged population and increased due to comorbidities. The use of biological treatments could be of interest in this condition.

Areas covered

This review takes into account literature data from the PubMed and clinical trial databases concerning the results of the use of biological treatments in PMR, in terms of efficacy and safety of these treatments.

Expert opinion

Current data do not allow us to identify any particular efficacy of the various anti-TNF agents used in the treatment of PMR. Anti-interleukin 6 agents (tocilizumab, sarilumab) have shown consistent efficacy results, suggesting a particularly interesting steroid-sparing effect in the population under consideration. The safety profile appears acceptable. Other biologic targeted treatments are currently being evaluated. Anti-interleukin-6 agents may well have a place in the therapeutic strategy for PMR, particularly for patients with steroid-resistant disease or at high risk of complications of corticosteroid therapy.

KEYWORDS:

• Polymyalgia rheumatica
• treatment
• biologic agents
• anti-TNF
• tocilizumab
• sarilumab
• rituximab
• abatacept

Article highlights

• PMR is a frequent inflammatory disease of the elderly

• Its treatment is based on corticosteroid therapy, at the cost of numerous side effects

• Biological treatments are being evaluated for this disease

• Anti-TNF agents have shown no notable efficacy

• Anti-IL-6 agents have demonstrated efficacy and a steroid-sparing effect

• Other targeted treatments are currently being evaluated

Declaration of interest

The author declares no financial interests and no long-term or permanent links. He received personal fees (speaking fees, advisory board) from: AbbVie, BMS, MSD, Pfizer, Roche Chugai Amgen, Nordic Pharma, UCB, Novartis, Lilly, Sandoz, Janssen, Galapagos, Celltrion. He declares indirect interests (hospitality, congress invitation) with: AbbVie, Pfizer, Roche Chugai, MSD, UCB, Fresenius Kabi, Galapagos. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.