Era of steroid sparing in the management of immune-mediated inflammatory diseases

Kondo, Tsuneo; Amano, Koichi

doi:10.1080/09114300.2018.1451593

Cited by 15 publications

(11 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although several issues might mitigate the use of TCZ for PMR, including the cost and risks of infection and dyslipidemia, TCZ monotherapy is a major candidate therapeutic strategy for PMR, particularly in older patients with comorbidities that prevent the use of GCs. Among recently reported GC‐sparing therapies for various immune‐mediated inflammatory diseases, our present findings clearly indicate that TCZ monotherapy for PMR is a promising alternative therapeutic strategy. Since almost all patients with PMR may initially respond to GCs, TCZ monotherapy should be used as the first remission induction therapy for patients with PMR presenting clinical problems that contraindicate GC use, such as multiple osteoporotic fractures, insulin‐dependent uncontrolled diabetes, and so on.…”

Section: Discussionsupporting

confidence: 68%

Tocilizumab monotherapy for polymyalgia rheumatica: A prospective, single‐center, open‐label study

et al. 2019

Self Cite

View full text Add to dashboard Cite

| INTRODUC TI ONPolymyalgia rheumatica (PMR) is a systemic inflammatory disease of unknown etiology. It mainly affects elderly people and rarely arises in people younger than 50 years old. Typical clinical features of PMR include proximal myalgia (particularly in the shoulder girdles), morning stiffness of the trunk, and elevated erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels. 1,2 Glucocorticoids (GC) remain the mainstay therapy for PMR 2,3 because they produce dramatic responses in most patients. However, approximately half of patients with PMR experience relapse after tapering of the GC dose. 2,4 Moreover, long-term GC therapy can produce substantial adverse events, such as osteoporotic compression fractures of the spine, diabetes, infections and cardio-cerebral vascular events. 2,5,6 Abstract Objectives: Polymyalgia rheumatica (PMR) is a systemic inflammatory disease in the elderly of unknown etiology. While glucocorticoids are the mainstay of treatment for PMR, various glucocorticoid-related adverse events are common. Recently, several studies have reported the efficacy of tocilizumab (TCZ), an anti-interleukin-6 receptor antibody, for PMR treatment in addition to an accompanying reduction, or even tapering-off, of glucocorticoids in some cases. The objective of this study was to elucidate the efficacy of TCZ monotherapy in the absence of glucocorticoids for PMR. Method:We conducted a 2-year, prospective, single-center, open-label pilot study of TCZ monotherapy in patients with PMR. TCZ (8 mg/kg) was administered at fortnightly intervals for the first 2 months and monthly over the next 10 months.Subsequently, patients were observed for another year without any treatment. The primary endpoints were the remission rates at weeks 12 and 52, and the secondary endpoints were the relapse rate and safety over the total 104 weeks.Results: Thirteen patients were included in this study. Four of these patients achieved remission at week 12 (remission rate 31%). Four patients withdrew from the study due to adverse events (n = 2) and inefficacy (n = 2). At week 52, all 9 patients who had completed the first year achieved remission. Eight patients completed the drug-free second year, with 7 maintaining remission.Conclusions: TCZ monotherapy is well tolerated and can lead to remission in most patients with PMR in the absence of glucocorticoids. K E Y W O R D Sglucocorticoid, interleukin-6, monotherapy, polymyalgia rheumatica, tocilizumab agents. We used 15 infusions of TCZ. However, if fewer TCZ infusions are sufficient to control PMR and TCZ treatment could be ceased, then these cost problems would be negated. Therefore, the optimal number of infusions of TCZ required to control PMR activity must be determined in the future. In addition, as TCZ monotherapy is expected to reduce adverse events related to GCs, such as osteoporosis, diabetes, dyslipidemia, and so on, the additional costs associated with the treatment of these adverse events will be reduced.Several limitations of our study warran...

show abstract

Section: Discussionsupporting

confidence: 68%

Tocilizumab monotherapy for polymyalgia rheumatica: A prospective, single‐center, open‐label study

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…[11][12][13][14][15] The results also mirror those for inflammatory diseases in which OCS was historically used, but in which the introduction of biologic therapy as a preferred treatment option has allowed for a substantial reduction in OCS use. 41 This study demonstrates that introducing mepolizumab as part of standard care for severe asthma in a range of health care environments enables a significant reduction in OCS burden.…”

Section: Discussionmentioning

confidence: 83%

REALITI-A Study: Real-World Oral Corticosteroid-Sparing Effect of Mepolizumab in Severe Asthma

Pilette

Canonica

Chaudhuri

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

View full text Add to dashboard Cite

“…Long-term treatment might also cause side effects such as gastric ulcers, especially when used in combination with NSAIDs. It is therefore of great importance to minimize GC treatment [67] or, ideally, to avoid initiation of GC treatment [33, 64, 92]. Indeed, tapering and discontinuation of GCs is a treatment objective for clinicians managing patients with Still’s disease in real life, as well as a relevant outcome in all clinical trials in Still’s disease.…”

Section: Review Of Available Data On Anakinra Treatment In Still’s DImentioning

confidence: 99%

Anakinra in children and adults with Still’s disease

et al. 2019

View full text Add to dashboard Cite

Systemic juvenile idiopathic arthritis and adult-onset Still’s disease are rare autoinflammatory disorders with common features, supporting the recognition of these being one disease—Still’s disease—with different ages of onset. Anakinra was recently approved by the European Medicines Agency for Still’s disease. In this review we discuss the reasoning for considering Still’s disease as one disease and present anakinra efficacy and safety based on the available literature. The analysis of 27 studies showed that response to anakinra in Still’s disease was remarkable, with clinically inactive disease or the equivalent reported for 23–100% of patients. Glucocorticoid reduction and/or stoppage was reported universally across the studies. In studies on paediatric patients where anakinra was used early or as first-line treatment, clinically inactive disease and successful anakinra tapering/stopping occurred in >50% of patients. Overall, current data support targeted therapy with anakinra in Still’s disease since it improves clinical outcome, especially if initiated early in the disease course.

show abstract

Era of steroid sparing in the management of immune-mediated inflammatory diseases

Cited by 15 publications

References 46 publications

Tocilizumab monotherapy for polymyalgia rheumatica: A prospective, single‐center, open‐label study

Tocilizumab monotherapy for polymyalgia rheumatica: A prospective, single‐center, open‐label study

REALITI-A Study: Real-World Oral Corticosteroid-Sparing Effect of Mepolizumab in Severe Asthma

Anakinra in children and adults with Still’s disease

Contact Info

Product

Resources

About