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Infliximab Potential Treatment for Corticosteroid-Resistant Polymyalgia Rheumatica

Infliximab could potentially replace long-term corticosteroid treatment of polymyalgia rheumatica (PMR), according to Italian researchers.

Most patients with PMR, a condition characterized by pain and stiffness in the hip and shoulder area, are treated with corticosteroids, such as prednisone. Unfortunately, short-term treatment is ineffective in about 30 to 50% of patients. Long-term corticosteroid (CS) treatment then becomes necessary; however, 65% develop at least one CS-related adverse event.

Infliximab, effective in the management of rheumatoid arthritis and ankylosing spondylitis, is one potential alternative treatment. Its effectiveness in PMR, however, remains unknown.

Carlo Salvarani, M.D., and colleagues at the Prato and Reggio Emilia Hospitals, Italy, performed a pilot study to test the efficacy of infliximab on the treatment of PMR in 4 women who had relapsed after CS treatment.

Patients received 3 intravenous infusions of infliximab (3 mg/kg) at 0, 2, and 6 weeks, based on current administration protocols for treatment of rheumatoid arthritis.

From their results, infliximab showed promise as an effective treatment for CS-resistant PMR with 3 out of 4 patients remaining symptom-free and showing normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels up to one year after initial treatment.

Increased levels of IL-6, the most sensitive marker of PMR activity, had previously been linked to PMR relapse. Interestingly, infliximab was able to significantly lower the level of IL-6 in all patients just 2 weeks after the first infusion, thus reducing risk of PMR relapse.

Importantly, steroid dose was reduced by about one-half just 2 weeks after first infusion and eventually eliminated in the 3 symptom-free patients, indicating infliximab's potential to replace long term CS treatment and in turn eliminate CS-related adverse events.

No side effects were reported in any of the patients up to 1 year after treatment.

"Our pilot study of 4 patients with steroid resistant PMR shows that infliximab could be useful as a steroid-sparing agent in this disease," said Dr. Salvarini. "Our encouraging results suggest that a controlled study may assess the efficacy of infliximab."
J Rheumatol 2003;30:4:760-763. "Treatment of Refractory Polymyalgia Rheumatica with Infliximab: a Pilot Study"

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