Table 2.

Pharmaceutical agents that have been used successfully in the treatment of PMR, and their evidence base

Drug	Dose	Summary of evidence	Recommendations a and comments	References
Oral GCs	Prednisolone 12.5–20 mg/day starting dose	1 OL‐RCT: lower relapse rate with 20 mg versus 10 mg Conflicting observational data	Individualized, gradual tapering recommended—higher relapse rate with rapid tapering	[73, 102]
I.m. GCs	MP 120 mg every 3 weeks, tapered	1 DB‐RCT: Lower cumulative GCs compared to oral GC course, similar remission rates, less weight gain	Conditionally recommended as alternative to oral GCs	[73, 77]
Methotrexate	7.5–10 mg/week (higher doses not evaluated)	1 DB‐RCT: Lower relapse rate, GC discontinuation more likely Similar observational data, OL‐RCT	Consider in early PMR for patients with high relapse risk. Refractory PMR not studied	[73, 103]
Azathioprine	100–150 mg/day	1 small DB‐RCT of patients with PMR ± GCA: GC‐sparing effect at 1 year	Limited evidence Not included in ACR/EULAR recommendations	[81]
Tocilizumab	162 mg s.c. weekly 8 mg/kg i.v. monthly	Post‐hoc subanalysis of GCA DB‐RCT Case reports and series on treatment success in PMR	Main evidence on PMR in the context of biopsy/imaging‐positive GCA	[84, 85]

^a Reflect ACR/EULAR recommendations [72].

Abbreviations: ACR/EULAR, American College of Rheumatology/European League Against Rheumatism; DB, double blind; GCA, giant cell arteritis; GCs, glucocorticoids; I.m., intramuscular; i.v., intravenous; MP, methylprednisolone; OL, open label; PMR, polymyalgia rheumatica; RCT, randomized controlled trial; s.c., subcutaneous.