Glucocorticoids serve as the mainstay of treatment for managing polymyalgia rheumatic treatment. However, longer treatment duration and steroid-related adverse events are the major challenges in using them in routine practice. Moreover, there are no glucocorticoid-sparing agents with proven therapeutic potential for managing polymyalgia. A recent study published in the Lancet Rheumatology has concluded on the efficacy of rituximab in combination with 17-week glucocorticoid treatment in achieving glucocorticoid-free remission in patients with polymyalgia rheumatica.
The double-blind, randomised, placebo-controlled, proof-of-concept trial enrolled patients with polymyalgia rheumatica who were unable to taper their prednisolone dose to <7ยท5 mg per day. The study subjects received a single IV infusion of rituximab 1000 mg or placebo, along with a 17-week glucocorticoid tapering scheme. Follow-up conducted at 21 weeks demonstrated that 48% of the 23 subjects who received rituximab and 21% of 24 subjects in the placebo group achieved glucocorticoid-free remission.
As per the present treatment guidelines, it is necessary to weigh the risks and benefits of long-term glucocorticoid therapy for managing the refractory or relapsing disease. Although certain studies have suggested the steroid-sparing effect of methotrexate, there is no evidence-based data suggesting a real substitute for steroid treatment. Further corroboration of the present study findings may assist in developing a glucocorticoid-sparing treatment for polymyalgia rheumatica. It will be beneficial for patients with poor prognoses and having contraindications for treatment with glucocorticoids.