0:03
Hi everybody. I'm Mike Putman. I'm a rheumatologist at the Medical College of Wisconsin and I'm reporting from ACR 2026 for RheumNow.
0:11
Today I want to talk about abstract 0167 which looked at the use of the interleukin-6 inhibitor sarilumab for patients with polymyalgia rheumatica.
0:18
Now this is from the SAPHIRE study. It's a post hoc analysis.
0:22
So it wasn't like the main goal of the study.
0:24
SAPHIRE was a great study that showed that the IL-6 monoclonal antibody worked for patients with polymyalgia rheumatica — you can get away with less steroids in that study — and had a higher rate of remission.
0:35
But a critical question that the study did not answer is when should you be initiating steroid-sparing therapies.
0:41
I'm on record as having said that steroid-sparing therapies are really kind of optional upfront.
0:47
For most of my patients, I am going with glucocorticoids because a substantial number of people really don't seem to need steroid-sparing therapies at diagnosis or when you first meet them.
0:58
This abstract somewhat challenges that notion and I wanted to share that today.
1:00
They did a couple things. First, they looked at the SAPHIRE trial itself and said among people who are randomized, how far into their disease course were they?
1:08
Were they in the first 6 months, or 6 to 12 months, or had they had disease for more than 12 months?
1:14
Interesting question, small numbers, but what they saw is that folks who started therapy within the first 6 months were more likely to be in remission.
1:22
So it kind of suggests that maybe earlier is better, but you know, there are only a couple people in each group, so maybe not strong enough.
1:27
They also looked at a real world data set and they said, you know, in a larger sample size of 340 people or so, if we look at people who initiated an IL-6 inhibitor earlier or later, how did things go?
1:40
And actually a similar finding — the hazard ratio for stopping steroids among the people who started steroid-sparing therapy latest was 0.59.
1:48
So it almost cuts your rate of being able to stop steroids in half.
1:53
Ultimately this is a very challenging question though, because there's a lot of confounding.
1:57
You could imagine someone who is sicker is the person who starts earlier and maybe has more room to get better, or alternatively the people who were delayed in initiating — perhaps those people were less likely to go into remission at all, and of course they had less remission later on.
2:11
So it's really hard to know if this is actually the study we need to answer this question, but it kind of tilts me a little bit more towards starting earlier.
2:17
The big takehome from it as usual is that there are way too many glucocorticoids given to these folks.
2:22
In the real world evidence analysis, people are getting over three grams of prednisone for PMR, which is enough to cause all of the corticosteroid badness that we're trying to avoid.
2:32
So interesting abstract — I think an important part of our evolving knowledge of when and how to use these steroid-sparing therapies in PMR.
2:40
Thanks so much for tuning in. Have a great day.
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