FRI0266 THE REAL-WORLD EFFICACY OF THE 2015 EULAR/ACR RECOMMENDATIONS FOR THE MANAGEMENT OF POLYMYALGIA RHEUMATICA WITH ADDITIONAL TOCILIZUMAB THERAPY

Abstract

Background:A Part of patients with polymyalgia rheumatica (PMR) are refractory to the 2015 EULAR/ACR algorism for the management of PMR. Recent reports have demonstrated that tocilizumab (TCZ) may be efficacious for refractory and relapsing PMR.Objectives:To determine the real-world efficacy of the 2015 EULAR/ACR algorism for the management of PMR plus introduction of TCZ for refractory and relapsing PMR.Methods:Patients who had been diagnosed with PMR according to the 2012 EULAR/ACR provisional classification criteria for PMR were recruited in the study. Registered variables included demographic data, disease characteristics, prednisolone (PSL) dosage and duration, addition of methotrexate (MTX) and TCZ, adverse effects, and clinical outcomes.Results:There were 101 patients who had originally diagnosed as PMR (50 males and 65 females) and followed up for at least one year; the mean ± SD age at onset was 73 ±11 years at onset, with the mean observational period being 44 ± 26 months. Their treatments were initiated with PSL of 15.5 ± 4.3 mg/day. 41 patients experienced disease recurrence after 9.6 ± 6.7 months (median 9 month) of GC therapy, while receiving PSL at 5 ± 4.5 mg/day (3.7 mg/day). Baseline factors that were associated with relapse in our cohort were higher-grade thrombocytosis and higher-dose of initial GC by multivariate analysis. In 30 of the 41 patients who failed GC monotherapy, MTX was added. Five patients reached GC-free remission, but 25 patients failed GC tapering. In such refractory patients to a combination of GC plus MTX, 8 patients agreed to add TCZ therapy, and 5 of them reached drug-free remission. At present, 67 of the total 101 patients maintained drug-free remission, but most others were still receiving low-dose GC and/or MTX (n=17). No significant adverse effects did not occur during therapy, except for GC-related adverse effects such as diabetes, dyslipidemia and osteoprotic fractures.Conclusion:Our experience indicated that there is notable heterogeneity across PMR patients in terms of drug response, and the patients with severe inflammation, e.g. thrombocytosis, may need higher-dose of initial GC and addition of biologics such as TCZ on the 2015 EULAR/ACR algorism.Acknowledgments:NoneDisclosure of Interests:None declared