The purpose of this study is to assess the efficacy of a tocilizumab-based regimen compared with placebo on top of rapidly tapered glucocorticoid treatment in a double- blind, controlled fashion, focussing on glucocorticoid-free remission of disease.
Background. Polymyalgia rheumatica is an inflammatory rheumatic disease of the elderly, with a usually rapid response to intermediate-doses of glucocorticoids (GCs). In many patients, relapses occur upon its dose reduction or cessation. Given the patients' age and the adverse event profile of GCs, steroid- free remission is the most desired target in patients with PMR, but typical GC sparing agents are often insufficient. Case series and small open studies suggested an excellent effectiveness of tocilizumab, an inhibitor of the Interleukin 6-receptor. Objective. To assess the efficacy and safety of a tocilizumab-based regimen compared with placebo on top of rapidly tapered GC treatment in a double-blind, controlled fashion, focussing on GC-free remission of disease. Methods. In this double-blind, parallel group study, 32 patients with PMR will be recruited from three rheumatology centres and will be randomised in a 1:1 ratio to tocilizumab or placebo over the course of 16 weeks, accompanied by a rapid tapering GC scheme over 11 weeks in both arms. The primary endpoint is GC-free remission at week 16, and follow-up will be performed until week 24 for safety and sustained efficacy. Patients will receive either the subcutaneous preparation of 162 mg tocilizumab weekly or matching placebo injections. Expected Results. In case of a positive result of this study, the benefits for patients with new-onset PMR will manifest in a reduction of the burden of GC intake in this elderly population with increased risk of GC-related adverse events.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
39
Weekly administration of Tocilizumab 162 mg subcutaneous from Baseline to Week 16.
Weekly administration of Placebo subcutaneous from Baseline to Week 16.
Rapidly tapered Glucocorticoid treatment. 20 mg/day of prednisone at randomization and a pre-specified taper regimen will be followed over 11 weeks: Week 0: 20 mg Week 1: 17,5 mg Week 2: 15 mg Week 3: 12,5 mg Week 4: 10 mg Week 5: 9 mg Week 6: 7 mg Week 7: 5 mg Week 8: 4 mg Week 9: 2 mg Week 10: 1 mg Week 11: 0 mg
Medizinische Universität Graz, Klinische Abteilung für Rheumatologie und Immunologie
Graz, Austria
Allgemeines Krankenhaus der Stadt Wien
Vienna, Austria
Krankenhaus Hietzing, 2. Medizinische Abteilung
Vienna, Austria
Proportion of subjects in GC free remission at week 16
Proportion of subjects in GC free remission at week 16
Time frame: Week 16
Cumulative prednisone doses at weeks 12, 16 and 24
Cumulative prednisone doses at weeks 12, 16 and 24
Time frame: Week 12, 16, 24
Number of flares per patient at weeks 12, 16 and 24
Number of flares per patient at weeks 12, 16 and 24
Time frame: Week 12, 16, 24
Time to first and second flare
Time to first and second flare
Time frame: 24 Weeks
Patient reported outcomes including SF-36
Patient reported outcomes including SF-36
Time frame: 24 Weeks
Patient reported outcomes including FACIT-Fatigue
Patient reported outcomes including FACIT-Fatigue
Time frame: 24 Weeks
Patient reported outcomes including HAQ
Patient reported outcomes including HAQ
Time frame: 24 Weeks
Patient reported outcomes including Patient Global Assessment of disease (PGA)
Patient reported outcomes including Patient Global Assessment of disease (PGA)
Time frame: 24 Weeks
Patient reported outcomes including Patient Assessment of pain
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Patient reported outcomes including Patient Assessment of pain
Time frame: 24 Weeks
Investigator reported outcomes including Evaluator Global Assessment of disease activity (EGA)
Investigator reported outcomes including Evaluator Global Assessment of disease activity (EGA)
Time frame: 24 Weeks
Investigator reported outcomes including Duration and severity of Morning Stiffness
Investigator reported outcomes including Duration and severity of Morning Stiffness
Time frame: 24 Weeks
Investigator reported outcomes including Elevation of upper limbs
Investigator reported outcomes including Elevation of upper limbs
Time frame: 24 Weeks
Occurrence of adverse events and serious adverse events, incidence of GC related adverse events, changes in vital signs, haematology and clinical chemistry parameters
Occurrence of adverse events and serious adverse events, incidence of GC related adverse events, changes in vital signs, haematology and clinical chemistry parameters
Time frame: 24 Weeks
Proportion of subjects with increased ESR (>20mm/h) and CRP levels (> 5mg/L) at week 24
Proportion of subjects with increased ESR (\>20mm/h) and CRP levels (\> 5mg/L) at week 24
Time frame: Week 24