Treatment of Refractory Polymyalgia Rheumatica with Infliximab: a Pilot Study

CARLO SALVARANI, FABRIZIO CANTINI, LAURA NICCOLI, MARIA GRAZIA CATANOSO, PIERLUIGI MACCHIONI, LIA PULSATELLI, ANGELA PADULA, IGNAZIO OLIVIERI, and LUIGI BOIARDI

ABSTRACT.

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. (J Rheumatol 2003;30:760-3)

Key Indexing Terms:

INFLIXIMAB
POLYMYALGIA RHEUMATICA
RELAPSING DISEASE

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From the Unità Reumatologica, Arcispedale S. Maria Nuova, Reggio Emilia; the Unità Reumatologica, 2nd Divisione di Medicina, Ospedale di Prato and the Istituto di Immunogenetica, Istituto Rizzoli, Bologna; and the Dipartimento di Reumatologia, Ospedale S.Carlo, Potenza, Italy.

C. Salvarani, MD; L. Boiardi, MD; M.G. Catanoso, MD; P. Macchioni, MD, Unità Reumatologica, Arcispedale S. Maria Nuova; F. Cantini, MD; L. Niccoli, MD, Unità Reumatologica, 2nd Divisione di Medicina, Ospedale di Prato; L. Pulsatelli, B, Istituto di Immunogenetica, Istituto Rizzoli; A. Padula, MD; I. Olivieri, MD, Dipartimento di Reumatologia, Ospedale S.Carlo.

Address reprint requests to Dr. C. Salvarani, Unità Reumatologica, Arcispedale S. Maria Nuova, V.le Umberto 1š N 50, 42100 Reggio Emilia, Italy. E-mail: salvarani.carlo@asmn.re.it

Submitted August 19, 2002; accepted September 9, 2002.

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