Efficacy and Safety of Tocilizumab in Polymyalgia Rheumatica: A Systematic Review and Meta-Analysis

IF 2.4 4区医学 Q2 RHEUMATOLOGY

International Journal of Rheumatic Diseases Pub Date : 2025-02-03 DOI:10.1111/1756-185X.70106

Meha Sharma, Siddharth Kumar Das, Ritin Mohindra, Deep Dutta

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引用次数: 0

Abstract

Aims

No meta-analysis has holistically analyzed and summarized the efficacy and safety of tocilizumab in polymyalgia rheumatica (PMR). We undertook this meta-analysis to address this knowledge-gap.

Methods

Electronic databases were searched for RCTs involving patients living with PMR receiving tocilizumab in intervention arm, and placebo/active comparator in control arm. Primary outcome was to evaluate percentage of patients able to achieve C-reactive protein PMR assessment score (CRP-PMR-AS) < 10 or prednisolone dose < 5 mg/day or > 10 mg/dL decline in prednisolone from baseline. Secondary outcomes were to determine percentage of patients able to totally stop prednisolone and adverse-events.

Results

From initially screened 115 articles, data from 2 RCTs (136 patients) was analyzed. In addition, a descriptive analysis of 8 observational studies (356 patients) was also done. After 24-weeks of clinical use, patients with PMR receiving tocilizumab had significantly higher chances of achieving composite primary end-point defined as CRP-PMR-AS < 10 and either prednisone dosage < 5 mg/day or decrease in prednisolone dosage by > 10 mg/day compared to baseline [odds ratio (OR) 4.89 (95% CI: 2.34–10.23); p < 0.001; I² = 0%], compared to placebo. Patients with PMR receiving tocilizumab also had significantly higher chances of being able to stop prednisolone compared to placebo [OR 4.45 (95% CI: 2.06–9.61); p < 0.001; I² = 0%]. Occurrence of total adverse-events [risk ratio (RR) 1.24 (95% CI: 0.50–3.12); p = 0.64; I² = 0%], adverse-events leading to treatment discontinuation [RR 0.45 (95% CI: 0.10–2.02); p = 0.29; I² = 17%], and infections [RR 1.71 (95% CI: 0.83–3.52); p = 0.14; I² = 6%] were comparable in patients receiving tocilizumab as compared to placebo. Observational studies have noted lung infections, neutropenia and increased cholesterol with tocilizumab use.

Conclusion

Tocilizumab is well tolerated and is effective for managing PMR. Tocilizumab is an effective glucocorticoid sparing agent in PMR.

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来源期刊

International Journal of Rheumatic Diseases RHEUMATOLOGY-

CiteScore

3.70

自引率

4.00%

发文量

362

审稿时长

1 months

期刊介绍： The International Journal of Rheumatic Diseases (formerly APLAR Journal of Rheumatology) is the official journal of the Asia Pacific League of Associations for Rheumatology. The Journal accepts original articles on clinical or experimental research pertinent to the rheumatic diseases, work on connective tissue diseases and other immune and allergic disorders. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer reviewed by two anonymous reviewers and the Editor.