In a matched claims analysis, 94% of patients with PMR initiating sarilumab discontinued glucocorticoids by 12 months vs 78% initiating methotrexate.
Sarilumab vs methotrexate glucocorticoid discontinuation in polymyalgia rheumatica
Patients with polymyalgia rheumatica (PMR) who initiated sarilumab (Kevzara) discontinued glucocorticoids more often and sooner than those initiating methotrexate, with the advantage persisting beyond 12 months, according to a real-world analysis presented at the
Sarilumab, an interleukin-6 (IL-6) receptor antagonist, is the only US Food and Drug Administration–approved therapy for glucocorticoid-dependent PMR, based on the phase 3 SAPHYR trial.1,2 Comparative real-world data vs methotrexate, commonly used off-label as a glucocorticoid-sparing agent, have been limited.¹
“It’s really shifted the landscape,” said Anisha B. Dua, MD, MPH, professor of medicine at Northwestern University and lead author of the analysis, in an earlier interview with RheumatologyLive. “We now have an approved steroid-sparing agent for this disease, and so that’s big.”
Dua and colleagues used the Komodo Research Dataset to identify previously treated patients aged 50 years and older with PMR who were receiving glucocorticoids at the start of sarilumab or methotrexate.¹ Patients were matched on age, glucocorticoid dose, prior GCA, and propensity score, yielding 258 matched pairs, of whom 115 pairs had at least 365 days of follow-up (mean age, 70.1 years).¹
In the 365-day subgroup, glucocorticoid discontinuation, defined as a gap of at least 60 days, was higher with sarilumab at six months (72% vs 55%; P = .006), eight months (84% vs 68%; P = .003), 10 months (89% vs 74%; P = .004), and 12 months (94% vs 78%; P < .001).¹
Cumulative glucocorticoid exposure with sarilumab in PMR
Median time to glucocorticoid discontinuation was 115 days with sarilumab vs 156 days with methotrexate in the full matched cohort (P < .001) and 109 vs 160 days in the 365-day subgroup (P = .015).¹ Median cumulative glucocorticoid dose over 12 months was 810 mg vs 1006 mg in the full cohort (P = .010), though the difference in the 365-day subgroup, 830 mg vs 987 mg, was not significant (P = .070).¹
Median weekly glucocorticoid doses among patients who discontinued did not differ between groups, and the investigators attributed the growing benefit primarily to higher discontinuation rates rather than dose reduction.¹
“We hate them, but we love them because they work fast,” Dua said of glucocorticoids in PMR, noting patients often face weight gain, sleep disruption, cataracts, diabetes, and fractures with prolonged exposure. “My personal feel is that every PMR patient should be seen by rheumatologists at least once.”
The analysis was retrospective, and glucocorticoid discontinuation was inferred from prescription claims rather than confirmed clinically.
Dua’s disclosures include Amgen, Abbvie, Astra Zeneca, Novartis, GSK, Sanofi, Zenas, Novartis, Rheumatology Research Foundation, Sebastian Unizony IQVIA, PTC Therapeutics, and Harvard Pilgrim Healthcare.
