Abatacept as Adjunctive Therapy in Refractory Polymyalgia Rheumatica
Bibliographic record
Abstract
To the Editor:Glucocorticoids (GCs) are the mainstay of treatment for patients with polymyalgia rheumatica (PMR). 1 Despite their efficacy, GCs are associated with well-known adverse events and a substantial proportion of patients with PMR do not respond adequately, or are refractory, to initial GC treatment.GC-sparing agents in PMR are limited to methotrexate (MTX). 1 More recently, favorable results were reported with tocilizumab (TCZ), an interleukin (IL)-6 receptor blocking agent, in patients with steroid-dependent/resistant PMR.2,3 The results of a randomized clinical trial of abatacept (ABA) suggested that this agent could be an adjunctive therapy in patients with giant cell arteritis (GCA).4 In this study, we aimed to evaluate the efficacy of ABA in patients with isolated PMR and who had GC-refractory disease.According to the French Regulatory Authority for clinical studies, prospective and retrospective studies consisting of observational analyses only do not need to obtain approval from ethics committees.The cases reported in this paper and this study design received no statement of opposition from the local ethics committee.As this study is a case series, written informed consent was not required due to its retrospective design.A call for observations of all cases of patients with PMR who received at least 1 injection (intravenously or subcutaneously) of ABA was sent to the members of a specialized French rheumatism and inflammation network (Club Rhumatismes et Inflammation: www.cri-net.com;including rheumatologists and specialists in internal medicine).Patients had to satisfy the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology criteria for PMR 5 and have isolated PMR, without symptoms or clinical signs of GCA.Over a 12-month period (from January 2019 to January 2020), 4 cases were identified: 2 men and 2 women (Table 1).The median (range) disease duration was 19 (7-48) months and the median duration of GC treatment before starting ABA was 42 (10-72) months.All patients required GC at a daily dose of 14 (10-20) mg.Before ABA administration, they had all received MTX treatment (17.5 [10-25] mg/week); 2 patients had been treated by an IL-6 receptor inhibitor without improvement.One patient had a contraindication to TCZ (previous history of diverticulitis), whereas the second did not accept this drug for fear of side effects.ABA treatment duration ranged from 3 to 18 months.Two patients (patients 3 and 4) responded to the treatment with a progressive decline in PMR activity score (patient 4), and/ or tapering of GC dosage over a 12-month follow-up period (patients 3 and 4).However, for these 2 patients, prednisone was not completely ceased (Table 1).There was no improvement in the other 2 patients.C-reactive protein levels decreased for
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".