glucocorticoid-free era for polymyalgia rheumatica: are we on the brink of change?

[Exflex]

Looks an interesting article… but to read in full one would need to subscribe.

‘Although the recently published treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica suggest minimising the use of glucocorticoids,1 these drugs are still the standard treatment for these diseases. In The Lancet Rheumatology, Alain Saraux and colleagues' Article on the BACHELOR trial,2 a randomised, double-blind, placebo-controlled study, reports impressive results on the use of baricitinib, a Janus kinase (JAK) inhibitor, to treat recent-onset polymyalgia rheumatica without the use of oral glucocorticoids.’

click.notification.elsevier...

[PMRpro Ambassador]

No we aren't, is probably the simple answer. That isn't what you'd call a massive nor a very long study and this gives pause for thought:

"The most common adverse events were musculoskeletal and connective tissue disorders (13 [72%] of 18 participants in the baricitinib group and four [25%] of 16 in the placebo group."

Nearly 3/4 of the study participants on the medication had musculoskeletal effects - in treating a musculoskeletal disorder. Doesn't sound very promising to me!!!

I can't see the BNF from here to look up the current price but 18 months ago, according to NICE it was over £800 per month. Not that much less than Actemra that is known to work well in PMR. As far as I know, JAK is involved in PART of the inflammatory mechanism in PMR - but, as in GCA, there appear to be multiple underlying sources of the inflammation and as such, a single drug is unlikely to be more than a steroid sparer to achieve 100% control. Except pred.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

I can’t access prices at present -except for same as you probably -

2.3 The list price of baricitinib is £805.56 for a 28‑tablet pack of either 2 mg or 4 mg tablets (excluding VAT, BNF online accessed October 2023).

[PMRpro Ambassador in reply to DorsetLady]

Yup - what I saw. That reads as if it is the same for 2mg or 4mg - bit strange!! And not cheap is it?

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

No, it’s not cheap, and 4mg seems to be recommended dose, but not sure I want to take a punt on it. Like many things, sometimes better the devil you know…