Treatment and prognostic factors in PMR: a systematic literature review informing German, Austrian and Swiss guidelines.

Abstract

To capture the current evidence on therapeutic interventions and prognostic factors in PMR informing a task force of the German, Austrian and Swiss rheumatology societies formulating the updated recommendations for the management of PMR. A systematic search of MEDLINE, EMBASE, Cochrane Library, Cinahl and Web of Science was conducted (July 2016-January 2024), supplemented by a search of grey literature. Included were interventional and prognostic studies (both prospective and retrospective) in pure PMR. Risk of bias (ROB) was assessed using Cochrane RoB 2, QUIPS and ROBINS-I tools. Findings were synthesized narratively due to study heterogeneity. A total of 24 publications on 10 interventional trials including one follow-up study, and 13 prognostic studies were included. Evidence from three trials with low ROB in new onset or relapsing patients consistently demonstrated higher remission rates and reduced glucocorticoid (GC) use in patients treated with an IL-6R inhibitor (tocilizumab or sarilumab). Single smaller trials indicated benefit of rituximab and tofacitinib, while MTX showed limited efficacy. Studies on prognostic factors were of variable quality and yielded inconclusive results. Fast-track clinics were associated with improved patient outcomes, including reduced hospitalization and earlier diagnosis. IL6-R inhibitors are effective GC-sparing agents in PMR; rituximab and tofacitinib are also promising. High-quality trials are needed to refine treatment strategies and establish reliable prognostic markers for clinical decision-making.