Real-world effectiveness and safety of tocilizumab in the management of polymyalgia rheumatica: a retrospective study from the KEIO-PMR cohort.

OBJECTIVE

This study aimed to evaluate the effectiveness and safety of tocilizumab in polymyalgia rheumatica (PMR) in the real world.

METHODS

All consecutive patients diagnosed with PMR who visited Keio University Hospital between May 2012 and October 2022 were retrospectively reviewed. Patients were divided into three groups: the tocilizumab group, the immunosuppressant group without biological agents, and the glucocorticoid monotherapy group. We collected clinical data including relapse, glucocorticoid doses, and adverse events during follow-up.

RESULTS

A total of 125 patients with PMR was included in the analyses, with a mean age of 73.6 years and 83 (66.4%) female. Among them, 52 (41.6%) were in the tocilizumab group, 23 (18.4%) in the immunosuppressant group, and 50 (40.0%) in the glucocorticoid group. The glucocorticoid group showed the lowest serum C-reactive protein level at diagnosis (P = 0.046). Tocilizumab extended the time to relapse, even when given to patients with a relatively refractory disease course, although relapse assessment was not independent of C-reactive protein levels. The time to glucocorticoid discontinuation was the shortest in the tocilizumab group (P < 0.001 for induction or re-induction, P = 0.08 for maintenance). Tocilizumab use, methotrexate use and the number of relapses were identified as significant predictors of achieving glucocorticoid-free status. Adverse events were not significantly different between the three groups.

CONCLUSION

Tocilizumab effectively reduced relapse rates and demonstrated glucocorticoid-sparing effects in patients with refractory PMR in the real world, with no significant safety issues. These results further support the existing evidence that tocilizumab may be a promising treatment option in real-world settings.