Research published in 2023 has demonstrated the efficacy of sarilumab for IL-6 blockade in polymyalgia rheumatica and of secukinumab for IL-17 blockade in giant cell arteritis (GCA). Furthermore, preliminary results with human monocyte-derived suppressive cells suggest the potential of cellular therapeutics for the treatment of GCA.
Key advances
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The safety and efficacy of sarilumab in patients with relapsing polymyalgia rheumatica was evaluated in the SAPHYR study, which demonstrated higher rates of sustained remission, lower rates of flares and less glucocorticoid exposure at 52 weeks in sarilumab-treated patients than in those treated with placebo5.
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Inhibition of IL-17 with secukinumab is an emerging therapeutic option for giant cell arteritis (GCA) that is currently being explored in a phase 3 study after promising results of the phase 2 TitAIN trial, in which 70% of secukinumab-treated patients achieved the primary outcome of sustained remission at week 28, compared with 20% of the placebo group6.
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In an ex vivo model of GCA using temporal artery specimens from patients with GCA, human monocyte-derived suppressive cells decreased the concentrations of proinflammatory cytokines and downregulated the expression of genes associated with inflammation and vascular remodeling, which suggests that these cells could have therapeutic value in GCA7.
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References
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Spiera, R. et al. Tocilizumab vs placebo for the treatment of giant cell arteritis with polymyalgia rheumatica symptoms, cranial symptoms or both in a randomized trial. Semin. Arthritis Rheum. 51, 469–476 (2021).
Bonelli, M. et al. Tocilizumab in patients with new onset polymyalgia rheumatica (PMR-SPARE): a phase 2/3 randomised controlled trial. Ann. Rheum. Dis. 81, 838–844 (2022).
Devauchelle-Pensec, V. et al. Effect of tocilizumab on disease activity in patients with active polymyalgia rheumatica receiving glucocorticoid therapy: a randomized clinical trial. J. Am. Med. Assoc. 328, 1053–1062 (2022).
Spiera, R. F. et al. Sarilumab for relapse of polymyalgia rheumatica during glucocorticoid taper. N. Engl. J. Med. 389, 1263–1272 (2023).
Venhoff, N. et al. Safety and efficacy of secukinumab in patients with giant cell arteritis (TitAIN): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Rheumatol. 5, e341–350 (2023).
Samson, M. et al. Human monocyte-derived suppressive cells (HuMoSC) for cell therapy in giant cell arteritis. Front. Immunol. 14, 1137794 (2023).
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L.L. has received consulting fees from Amgen/ChemoCentryx. R.S. has received grants and/or research support from, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, ChemoCentryx, Corbus, Cytori, Formation Biologics, GSK, Novartis and Roche-Genentech, and consulting fees from Abbvie, AstraZeneca, ChemoCentryx, Cytori, Galderma, GSK, Janssen, Novartis, Ortho Dermatologics, Roche-Genentech and Sanofi.
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Lally, L., Spiera, R. Advances in the treatment of polymyalgia rheumatica and giant cell arteritis. Nat Rev Rheumatol 20, 77–78 (2024). https://doi.org/10.1038/s41584-023-01069-2
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DOI: https://doi.org/10.1038/s41584-023-01069-2
