RT Journal Article
SR Electronic
T1 Treatment of refractory polymyalgia rheumatica with infliximab: a pilot study.
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 760
OP 763
VO 30
IS 4
A1 Carlo Salvarani
A1 Fabrizio Cantini
A1 Laura Niccoli
A1 Maria Grazia Catanoso
A1 Pierluigi Macchioni
A1 Lia Pulsatelli
A1 Angela Padula
A1 Ignazio Olivieri
A1 Luigi Boiardi
YR 2003
UL http://www.jrheum.org/content/30/4/760.abstract
AB OBJECTIVE: To investigate whether infliximab has a steroid-sparing effect in the treatment of patients with polymyalgia rheumatica (PMR) who are resistant to corticosteroid (CS) therapy and have had CS-related side effects. METHODS: In a pilot study, infliximab 3 mg/kg was administered at weeks 0, 2, and 6 in 4 patients with relapsing PMR who were not able to reduce their prednisone dose below 7.5-12.5 mg/day and who had experienced multiple vertebral fractures. The patients were regularly monitored for clinical signs/symptoms and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) during the one-year followup period. RESULTS: Two patients had a complete response to infliximab with clinical remission 2 weeks after the first infusion. At this time ESR and IL-6 values were normal and the patients were able to suspend prednisone. Normal ESR, CRP, and IL-6 levels persisted after the suspension of infliximab and prednisone during the followup period, paralleling the clinical remission. The third patient had a complete and persistent clinical remission 2 weeks after the first infusion, although IL-6 levels remained elevated during the followup period despite the normalization of ESR values. These 3 patients were symptom-free with normal ESR and CRP at the end of 1-year of followup. The fourth patient had continuous clinical activity associated with persistently elevated acute phase reactants, although IL-6 levels measured during followup were lower compared to baseline values and the patient was able to reduce prednisone dosage to 5 mg/day. CONCLUSION: Our encouraging results suggest that a controlled study may assess the efficacy of infliximab as CS-sparing drug in PMR.