Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition primarily managed with glucocorticoids (GCs), but prolonged GC use carries significant adverse effects. Tocilizumab, an interleukin−6 receptor inhibitor, has emerged as a promising steroid-sparing therapy for patients with relapsing or GC-dependent PMR. We conducted a systematic review and meta-analysis according to PRISMA guidelines to assess the efficacy and safety of tocilizumab in PMR. Four randomized controlled trials (RCTs) involving 317 patients were included in the meta-analysis, and one multicentre observational cohort was narratively synthesized to provide supportive real-world evidence. Relapse outcomes were categorized as short-term (≤ 12 weeks), medium-term (13–26 weeks), and long-term (> 26 weeks). Pooled analysis showed that tocilizumab significantly reduced short-term relapse rates (OR: 0.22, 95% CI: 0.12–0.41; I² = 22.5%) and medium and long-term relapse rates (OR: 0.19, 95% CI: 0.10–0.35; I² = 27.1%) compared to placebo. Tocilizumab also significantly lowered cumulative GC dose (SMD: -0.78, 95% CI: -1.21 to -0.23; I² = 84.5%). Severe relapse showed a non-significant trend favoring tocilizumab, and safety outcomes were comparable between groups (OR: 0.57, 95% CI:0.27–1.18; I² = 30.0%). The included observational study supported these results, demonstrating high rates of successful tapering (77% to ≤ 5 mg at six months; 97% at twelve months) with few adverse events. This updated synthesis supports tocilizumab as an effective steroid-sparing option in PMR and provides practical tapering guidance to assist clinicians in managing relapsing or GC-dependent cases.
Bungish et al. (Sat,) studied this question.