A steroid-free alternative for treating rheumatic condition

Scientists from Anglia Ruskin University (ARU) have found success in treating an arguably neglected inflammatory condition, polymyalgia rheumatica, with a drug that could provide an alternative to steroids for patients. Their results have been published in The New England Journal of Medicine.

Polymyalgia rheumatica (PMR) is characterised by pain and morning stiffness in the shoulder and hips, and affects people over the age of 50. It is currently mainly treated with glucocorticoids — a class of steroid hormones — but although glucocorticoids can control the condition, more than half of PMR patients suffer relapse of their condition when reducing their steroid medication.

“Polymyalgia rheumatica is a poorly managed and neglected condition for which current treatment is unsatisfactory and can have long-term side effects,” said senior study author Professor Bhaskar Dasgupta, from ARU. “Patients can have relapses while tapering their medication, and these relapses currently have very limited treatment options.”

The protein interleukin-6, which can cause inflammation, has been implicated in the pathophysiology of PMR because circulating elevated levels and increased tissue expression of interleukin-6 have been found in PMR patients. The drug sarilumab is an injectable interleukin-6 receptor blocker, which has been approved in the UK and the US to treat rheumatoid arthritis.

In a year-long clinical trial, 118 patients either received injections of sarilumab twice a month or a placebo. The sarilumab group received a 14-week tapering dose of glucocorticoid in conjunction with twice-monthly injections of sarilumab, while the placebo group received glucocorticoid at a tapering dose for 52 weeks.

The primary outcome at the end of the trial was sustained remission of the condition. This occurred in 28% of people taking the sarilumab, compared to 10% of people taking the placebo. After entering remission after 12 weeks, there were more flare-ups of the condition in the placebo group (57%) compared to those receiving sarilumab (24%).

“Our findings show promise that sarilumab could be used to treat PMR and improve outcomes for people tapering their steroid medication,” Dasgupta said. “This is an exciting development that has potential to improve treatment options in a condition that is common among older people.

Sarilumab has now been approved by the US FDA for the treatment of PMR in adult patients who have had an inadequate response to steroids or who cannot tolerate steroid taper. Dasgupta concluded, “Any effective medication that can spare the use of steroids should have great impact on reducing the serious side effects of such steroids, which can include diabetes, osteoporotic fractures and infections.”

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