Dados do Trabalho

Título

The use of IL-6 inhibitors for the treatment of Polymyalgia rheumatica (PMR) and Giant Cell Arteritis (GCA): A Systematic Review and Meta-analysis

Resumo

Background: Polymyalgia rheumatica (PMR) and Giant Cell Arteritis (GCA) are closely linked inflammatory disorders and more common in the elderly. Current recommended treatment consists of low or intermediate-dose glucocorticoids, although relapses are common, and the adverse effects of long-term therapy may discourage their use. In this context, IL-6 inhibitors (IL6i) might serve as an alternative option for these patients.
Objectives: To evaluate the efficacy and safety of IL6i (tocilizumab, sarilumab) plus glucocorticoid therapy compared to glucocorticoid therapy alone in the management of PMR and/or GCA.
Methods: PubMed, Embase, and Cochrane Central databases were systematically searched for randomized controlled trials (RCT). Statistical analyses were performed using R language 4.3.1. Odds ratio (OR) was used for binary outcomes and mean difference (MD) with standard deviation (SD) for continuous outcomes with their respective 95% confidence interval (CI).
Results: 6 RCTs with 618 patients (339 on IL6i vs. 279 on placebo) were included. Patients treated with IL6i demonstrated a significantly higher disease remission rate for all timepoints of for all time points: 24 weeks (RR: 2.08; 95% Cl: 1.11; 3.91; p = 0.02) and 52 weeks (RR: 3.25; 95% Cl: 2.24, 4.71; p<0.01). The cumulative corticosteroid dose was significantly higher in the placebo group at 24 weeks (MD: -470.51 mg; 95% Cl: -817.79, -123.13; p< 0.01) and at 52 weeks (MD: -1454.82 mg; 95% Cl: -1623.83, -1285.81; p< 0.01). Flares were significantly less frequent in the IL6i group (RR: 0.55; 95% Cl: 0.31; 0.96; p = 0.04). There was no significant difference in the overall adverse event rate comparing both groups (RR: 1.09; 95% Cl: 0.97; 1.23; p = 0.15), but there was a significantly higher incidence of infections in the IL6i group (RR: 1.28; 95% Cl: 0.94; 1.73; p<0.01).
Conclusion: IL6i was associated with an improvement in disease remission and fewer occurrences in patients with PMR and/or GCA.