MELBOURNE, Australia — People with relapsing polymyalgia rheumatica (PMR) who were treated with the anti-interleukin (IL)-17A monoclonal antibody secukinumab had twice the rate of sustained remission compared with those on placebo, according to a presentation at the 22nd International Vasculitis Workshop (IVW) 2026.

PMR is the second most common inflammatory rheumatic disease affecting adults older than 50 years. The first-line treatment option of glucocorticoids often must be used long-term for PMR and is associated with multiple adverse outcomes, and currently, only the IL-6 receptor antagonist sarilumab is approved for patients with an inadequate response to glucocorticoids or who cannot tolerate a glucocorticoid taper.

Secukinumab is already approved for the treatment of plaque psoriasis, ankylosing spondylitis, psoriatic arthritis, nonradiographic axial spondyloarthritis, enthesitis-related arthritis, and hidradenitis suppurativa.

John Stone, MD, a rheumatologist at Massachusetts General Hospital and Harvard Medical School in Boston, presented data from the phase 3, randomized, double-blind, placebo-controlled REPLENISH trial, which involved 381 adults aged 50 years or older with relapsing PMR.

Participants were randomly assigned to 300 mg or 150 mg of secukinumab or placebo for 52 weeks, combined with a 24-week tapering prednisone regimen.

At 52 weeks after starting therapy, 41.2% of patients in the 300-mg regimen group and 40.6% of patients in the 150-mg group had achieved sustained remission — defined as no recurrence of disease signs or symptoms from week 12 to week 52 — compared with 20.4% of patients in the placebo group, a difference that was highly significant.

A similar effect was seen with complete sustained remission, which researchers defined as remission from week 12 to week 52 with no elevation in erythrocyte sedimentation rate and normalization of highly-sensitive C-reactive protein levels. Complete sustained remission occurred in 28.2% of those in the 300-mg group vs 24.5% of those in the 150-mg group and 4.7% of those in the placebo group.

“It is clear that patients who are experiencing a relapse of their PMR after a disease remission will benefit from this medication,” Stone told Medscape Medical News.

Patients in the secukinumab groups also required significantly less glucocorticoids than those in the placebo group, with a mean adjusted annual cumulative dose of 1604 mg in the 300-mg group, 1683 mg in the 150-mg group, and 2093 mg in the placebo group.

“It is also clear that patients who are at high risk of doing poorly with prolonged glucocorticoid use may benefit substantially from the early use of secukinumab, perhaps even as part of the primary treatment approach,” Stone said.

He noted that even a small reduction in overall glucocorticoid use was associated with clinically significant reductions in glucocorticoid toxicity. “The opportunity to reduce glucocorticoid toxicity in this population of patients who are already at high risk by virtue of being elderly and predominantly female constitutes a major advance in the field.”

Secukinumab treatment also significantly extended the time to first use of escape or rescue treatment. Only 50.8% of patients in the 300-mg secukinumab group required rescue treatment compared with 75.6% of patients in the placebo group.

The overall rate of adverse events was similar between the three groups, and the number of discontinuations due to treatment-related adverse events was actually highest in the placebo group.

Commenting on the presentation, Xavier Puéchal, MD, PhD, of the Reference Center for Rare Systemic Autoimmune Diseases at Cochin Hospital and Paris Cité University in Paris, said the proof-of-concept study showed that IL-17 inhibition could improve patient outcomes and spare glucocorticoids.

“I think it’s a very positive point for patients with relapsing polymyalgia rheumatica, that there is an option which has proven now to be efficacious,” he told Medscape Medical News.

However, Puéchal noted that the same positive effects of secukinumab had not been seen in a phase 3 trial of patients with giant cell arteritis, where the primary endpoint was not reached. “So it remains to be seen in detail to be able to know whether it’s a problem of design of study [or] whether it’s problem of dosage — should we evaluate it at higher dosage in GCA patient?” he said.

This study was sponsored by Novartis. Stone disclosed receiving consulting fees from Novartis that were paid to his institution. Some of his coauthors reported having financial relationships with Novartis, and some coauthors reported being Novartis employees who may have held company stock.