Direct interleukin-6 inhibitor olokizumab in the treatment of polymyalgia rheumatica: a case series

Objective To describe the experience of using olokizumab (OKZ) in patients with polymyalgia rheumatica (PMR) who have contraindications or an inadequate response to methotrexate and require steroid-sparing therapy, and to analyze treatment outcomes in this cohort. Methods A case series included 23 patients with PMR [including giant-cell arteritis (GCA) in 9 patients] treated with OKZ. The assessment of disease activity was carried out using the PMR-activity score (AS) index, as well as laboratory parameters [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)]. The statistical analysis was performed using the StatTech v program. 4.7.3. Results Olokizumab therapy resulted in a significant decrease in PMR activity: the PMR-AS index decreased from 18.6 (14.2–24.4) to 3.01 (1.62–6.09) points by 12–24th weeks. Most patients (86.3%) who received therapy achieved remission or low disease activity. Laboratory parameters have also improved: ESR values decreased from 32.00 (20.00–47.00) to 7.00 (5.00–8.50) mm/h, and CRP – from 14.10 (8.10–40.80) to 0.85 (0.30–2.15) mg/l. The steroid dose decreased from 7.5 (5.0–15.0) to 2.50 (0.00–2.50) mg/day by week 24. The results listed above were statistically significant ( p < 0.05). The disease duration of less than 36 months at the time of initiation of therapy proved to be a significant predictor of achieving low PMR activity (AUC = 0.912; p = 0.024). Conclusion Olokizumab demonstrated high efficacy in reducing the activity of PMR, laboratory markers of inflammation and the dose of steroids in patients with inefficacy or intolerance to methotrexate.