Groundbreaking discovery for neglected rheumatic disorder

Using sarilumab in glucocorticoid taper for polymyalgia rheumatica.

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Researchers at Anglia Ruskin University have discovered a new way to treat an overlooked inflammatory condition called polymyalgia rheumatica. They conducted a successful trial using sarilumab, a drug already approved in the UK for rheumatoid arthritis. Sarilumab blocks a protein called interleukin-6, which is known to cause inflammation. This could be a promising alternative to steroid treatments for patients with this condition.

In a year-long clinical trial, 118 patients were divided into two groups. One group received sarilumab injections twice a month, while the other received a placebo. The sarilumab group also got a 14-week tapering dose of glucocorticoid alongside the injections. In contrast, the placebo group received glucocorticoids for 52 weeks.

The trial’s main goal was to see if the condition could be in remission by the end. It turned out that 28% of the people taking sarilumab achieved sustained remission, while only 10% of the placebo group did. After 12 weeks, there were more flare-ups of the condition in the placebo group (57%) than those receiving sarilumab (24%). This shows that sarilumab was more effective in controlling the disease and reducing flare-ups.

Leading PMR expert and senior author of the study, Professor Bhaskar Dasgupta, from the Medical Technology Research Centre at Anglia Ruskin University (ARU), said, “Polymyalgia rheumatica is a poorly managed and neglected condition for which current treatment is unsatisfactory and can have long-term side effects. Patients can have relapses while tapering their medication, and these relapses currently have minimal treatment options.”

“Our findings show promise that sarilumab could be used to treat PMR and improve outcomes for people tapering their steroid medication,” he added.

This exciting development could potentially improve treatment for a common condition in older people. Polymyalgia rheumatica (PMR) often requires long-term steroid use, which can lead to serious side effects like diabetes, fractures, and infections. Finding an effective medication that reduces the need for steroids could greatly benefit patients.

Sanofi and Regeneron Pharmaceuticals funded the research.

Earlier this year, Professor Dasgupta and colleagues published a review in the journal Nature Reviews Rheumatology, suggesting that patients with relapsing PMR may also have an underlying condition called Giant Cell Arteritis, which causes inflammation in the main blood vessel (aorta) and its branches. They proposed that both conditions should be treated under the term “GCA-PMR Spectrum disease (GPSD).

The study’s findings represent a remarkable advancement in polymyalgia rheumatica (PMR) treatment. Using sarilumab offers hope for effectively managing PMR while reducing the adverse effects of steroid therapy, providing a significant breakthrough in improving the quality of life for PMR patients, especially the older people. This discovery paves the way for future research and clinical applications, promising a brighter outlook for those affected by this often-overlooked rheumatic condition.

Journal reference:

  1. Robert F. Spiera, M.D., Sebastian Unizony, M.D., et al., Sarilumab for Relapse of Polymyalgia Rheumatica during Glucocorticoid Taper. The New England Journal of Medicine. DOI: 10.1056/NEJMoa2303452.

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